Eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EE) is an allergic or idiopathic disease of the esophagus. The most characteristic symptom of EE is dysphagia, which may be accompanied by food impaction. Eosinophilic infiltration of the esophagus is the main marker for the disease and endoscopic biopsy of the distal and proximal esophagus and histology is the only way to establish the diagnosis of EE. Endoscopic findings include concentric rings or web like strictures, an appearance resembling feline esophagus, longer strictures and small caliber esophagus, corrugation, vertical furrows, patchy whitish exudates or tiny white papules. Treatment of EE with proton pump inhibitors has been found to be ineffective. Eliminations diets or anti-inflammatory medications (corticosteroids) are helpful to induce remission in patients with EE. An attractive alternative to systemic corticosteroids is the administrations of topical corticosteroids. For patients with strictures or rings unresponsive to medical treatment, in whom dysphagia persists, endoscopic dilatation should be performed but this involves high risk for deep mucosal tears and esophageal perforation. More studies, especially in adults, are needed to determine the long term management and the best treatment strategy.