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. Elimination diets or anti-inflammatory medications
(corticosteroids) are helpful to induce remission
in patients with EE. An attractive alternative to systemic
corticosteroids is the administration 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.