Eosinophilic esophagitis

Abstract

Eosinophilic esophagitis is a new disease commonly confused with gastroesophageal reflux disease. Because of different treatments, recognition of eosinophilic esophagitis is important. Recent work further characterizes the allergic response, demonstrating a population of eosinophils different from gut and blood that specifically homes to the esophagus in eosinophilic esophagitis. Further data suggest a multi-step allergy process starting with an atopic skin response that later primes the esophagus on further allergen exposure. Diagnosis of eosinophilic esophagitis is suggested by food impaction in a young adult with a personal and family history of allergy. Barium radiography may be useful for obvious signs of eosinophilic esophagitis including rings and strictures. Treatment is based on systemic or topical steroids or identification and elimination of food allergens sometimes with elemental diets. Recent data show the latter to be superior both for the short and long term but with the caveat of compliance being difficult. Eosinophilic esophagitis is an allergy-based disorder. It presents commonly in adults as long standing dysphagia, sometimes with food impaction. Radiography is useful but will miss subtle signs of eosinophilic esophagitis. Treatment options are limited to steroid formulations or avoidance of food allergens though compliance, particularly with elemental formulas, remains problematic.