Eosinophilic Esophagitis

By professional definition, Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.

Basically EoE is a medical condition caused by excess of allergic cells, eosinophils, migrate into the esophagus as a reaction to foods, allergens or acid reflux, etc, which produces damage to the esophagus and affects the function of the esophagus.

The exact cause of EoE is unknown, although it is known to be an immune related process due to certain foods, allergens or acid reflux, etc.

EoE is an immerging medical condition recognized more frequently in recent years. It affects both children and adults. Although the fundamental is the same, the clinical presentations in children and adults are different. Here we mainly talk about adult form.

Diseases that mostly associated with EoE:

  • GERD
  • Eosinophilic gastroenteritis
  • Crohn's disease
  • Celiac disease
  • Vasculitis
  • Achalasia
  • Parasite infection
  • Hypereosinophilic syndrome
  • Drug reaction
  • Connective tissue disease
  • Graft versus host disease (GVHD)

Symptoms of EoE:

Common symptoms of EoE are:

Diagnosis of EoE

Usually involves one or more of the following tests:

  • Endoscopy with esophageal biopsy remains the most reliable diagnostic test for EoE.
  • PH study. Esophageal Ph monitoring with impedance, is a useful diagnostic test to evaluate for GERD in patients with esophageal eosinophilia.
  • Allergist or Immunologist evaluation.
  • Aeroallergen sensitization is warranted.
  • Serum IgE and skin prick testing.
  • No surrogate marker available yet.
  • IgE level is not a surrogate disease indicator.
  • No role for genotype testing

Treatment

Treatment generally involves one or more of the following modalities:

1. Medications:

-Proton pump inhibitors (PPI)

-Dietary therapy

-Steroids, including topical and systemic steroids.

-Other medications which are in experimental stage

2. Endoscopic therapy

References:

  1. PubMed Health.
  2. Wikipedia.
  3. Mayo clinic online health information.
  4. Sleisenger and Fordtran's Gastrointestinal and Liver Disease- by Mark Feldman MD, et al.
  5. The Little Black Book of Gastroenterology-by David W. Hay.
  6. Principles of Clinical Gastroenterology by Tadataka Yamada, et al.


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