Immune mediated chronic disease with symptoms of esophageal dysfunction, eosinophilic infiltration of the esophagus that persists after a proton pump inhibitor trial, and excludes secondary causes of eosinophilia.
Its incidence is increasing perhaps related to increased awareness of the diagnosis, increased biopsy sampling of the esophagus, and the generalized increase in atopic diseases.
This threshold is 100% sensitive and 96% specific for diagnosis.
Also known as allergic esophagitis.
Directly related to food antigens.
Leading cause of emergency department visits for food impaction in the US.
Increasing incidence and prevalence may be due to increased recognition as well as an increase in atopic diseases.
The second most common cause of chronic esophagitis, the first being gastroesophageal reflux disease.
A leading cause of esophageal morbidity among children and adults.
The diagnosis of pediatric EoE is increasing at an alarming rate and affects approximately four of every 10,000 children in the US.
A leading cause of dysphagia.
The onset can be insidious, and diagnosis is often delayed with the potential for the development of irreversible sequelae.
Effects infants, children, and adults.
A worldwide process with highest degree of disease in North America, Western Europe, and Australia.
Prevalence in the US estimated from 40-90 cases per 100,000 persons.
The prevalence ranges from 12-22% among patients undergoing upper endoscopy for evaluation of dysphasia.
Etiology incompletely understood, but suggests activation of Th2 immune cells.
Patients frequently have a history of atopic disease or food allergies.
Endoscopic features include: linear furrows and mucosal rings, extensive infiltration of eosinophils and epithelial hyperplasia.
Allergen-free formulas are utilized to treat the condition.
Dietary antigens can be triggers of disease and it is suspected environmental factors play a larger etiologic roll and than genetics.
Symptoms are swallowing difficulty, food impaction, and heartburn.
Characterized by symptoms and signs of esophageal dysmotility from underlying chronic inflammation of the esophagus.
Characterized by eosinophilic infiltration into the esophagus that persists after a proton pump inhibitor trial.
Chronic inflammation leads to remodeling of the esophagus including fibrosis, rings, linear furrows, and stricture formation.
Children tend to present with vomiting, abdominal pain, and or a failure to thrive, while adults often have dysphagia, food impaction, and heartburn.
The treatment may consist of removal of known or suspected triggers, medication to suppress the immune response, but it may be necessary to dilate the esophagus.
EE has no approved treatments.
BecauseEE is a non-IgE mediated allergic disease, attempts to eliminate allergens may result in disease remission in some patients.
Dietary therapy includes: an elemental diet of drinking of formula without any intact proteins, empirical food elimination, and allergy test directed food elimination.
An elemental diet consists of a liquid form of nutrition with amino acids, fats, sugars, vitamins, nutrients that are readily assimilated and absorbed.
An elemental diet is associated with a 93.6% histologic remission rate compared with 13.3% for a historical placebo.
An elemental diet is costly, inconvenient, associated with an undesirable taste, and it can be difficult to insure sufficient formula to maintain weight.
Elimination of foods associated with EE include: milk, wheat, eggs, soy, peanuts/tree nuts, and fish/shellfish.
This dietary elimination diet is associated with the histological response in EE of 67.9% of patients compared with 13.3% in historical placebo comparison group.
Dairy, wheat, and eggs are the most commonly implicated food groups.
PPIs in EE may have anti-inflammatory effects independent of gastric acid suppression with antioxidant properties, inhibition of immune cell function, and reduction of epithelial cell inflammatory cytokines expression.
PPI therapy is associated with a 40% histological and 60% clinical response in EE.
PPIs are a reasonable first line therapy.
Swallowed corticosteroids or the mainstay of treatment for EE, but no formulations are approved yet by the FDA.
Fluticasone swallowed twice daily from a multidose inhaler or oral viscous budesonide are efficacious.
Topical corticosteroid treatment has a response rate with histological remission in up to 65% of patients.
Young children may present with feeding difficulties and poor weight gain.
More common in males.
Many patients with have other autoimmune and allergic disease, including asthma and celiac disease.
Histologically, characterized by a dense infiltrate with white blood cells of the eosinophil type into the epithelial lining of the esophagus.
Thought to be an allergic reaction against ingested food, based on the important role eosinophils play in allergic reactions.
Eosinophils inflame the surrounding esophageal tissue.
Visible redness on endoscopy, and
Natural history that may include stricturing.
Endoscopic image of esophagus includes concentric rings termed trachealization of the esophagus.
The barium swallow of the esophagus shows multiple rings associated with eosinophilic esophagitis.
Endoscopically, ridges, furrows, or rings may be seen.
The diagnosis made on the combination of symptoms and findings on diagnostic testing.
The disease affects the esophagus and then a regular, patchy pattern and at least five or more biopsies should be obtained for diagnosis.
Does not respond to a 6 week trial of proton-pump inhibitors (PPIs.
White exudates in esophagus is also suggestive of the diagnosis.
On biopsy numerous eosinophils seen in the superficial epithelium, with a minimum of 15 eosinophils per high-power field are required to make the diagnosis.
Eosinophilic inflammation extends through the whole gastrointestinal tract.
Treatments include an elimination diet, proton pump inhibitors, topical steroids, dilation.
Treatment is with swallowed liquid corticosteroids and other anti-inflammatories.
Patients with severe symptoms may require oral corticosteroids.
Mechanical dilatation may be considered in cases that have progressed to esophageal stricture or severe stenosis.
Endoscopic dilatation is an option for treating esophageal strictures, rings, and narrow caliber esophagus from eosinophilic esophagitis.
Esophageal dilatation is associated with clinical improvement in 95% of patients with EE and a median duration of improvement of 12 months.