Eosinophilic Esophagitis

Eosinophilic esophagitis is a chronic inflammatory disease of the esophagus which affects children and adults. It is a clinicopathological diagnosis and symptoms of esophageal dysfunction along with histological finding of at least 15 eosinophils per high power field in the biopsy specimen of the esophagus are required for diagnosis. Eosinophilic inflammation should be confined to the esophagus and other causes of esophageal eosinophilia have to be excluded. The prevalence and incidence have been increasing for the past two decades. Although the disease has been reported worldwide, it has been most commonly reported in the American continent and Europe. It affects white individuals and males more commonly than other races and female population. The disease is highly associated with atopic conditions, food, and aeroallergen hypersensitivities are common findings in patients with EoE.

T-helper lymphocyte-mediated inflammation is the basis of pathogenesis. A unique EoE transcriptome has been identified which differentiates this condition from gastroesophageal reflux disease.

The presenting symptoms vary by age, with dysphagia being the most common in adults. The most common and worrisome complication is esophageal stricture due to fibrosis induced by persistent inflammation. The disease does not resolve without treatment but has a waxing and waning nature.

Treatment modalities may include one or any combination of dietary modification, topical steroids, and treatment of comorbid conditions. Endoscopic dilatation of esophagus could be considered in patients presenting with fibrotic changes. Biological agents have been investigated but at this time not available for clinical use.