Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic immune disorder characterized by esophageal dysfunction mediated by eosinophils. The diagnostic criteria for EoE as determined by a 2018 expert consensus requires symptoms of esophageal dysfunction, at least 15 eosinophils per high power field on esophageal biopsy, and the exclusion of other causes of esophageal eosinophilia. Food antigens, and possibly inhaled molecules, trigger cytotoxic and antibody-mediated responses that recruit eosinophils to the esophageal mucosa and induce inflammation. This inflammation leads to the fibrosis and tissue remodeling that can result in symptoms and structural changes in the esophagus. EoE affects both children and adults. Children typically present with nonspecific symptoms such as feeding problems and abdominal pain, whereas adults commonly experience dysphagia and food impaction. Symptoms in adults can present similarly to those of GERD, and GERD and EoE have a complex relationship with overlapping features. Diagnosis is made via endoscopy with biopsy. Characteristic endoscopic findings include exudates, rings, edema, furrows, and strictures. Biopsies will show greater than 15 eosinophils per high power field. A contrast esophagram can be helpful by identifying strictures that may not be apparent on endoscopy. Treatment options include dietary modification, medications, and endoscopic dilation. Dietary modification involves elimination of allergenic foods. Medications include proton pump inhibitors and topical glucocorticoids. Endoscopic dilation can provide symptomatic relief and is usually reserved for patients who have failed conservative treatment.