Clinical and Endoscopic Features of Eosinophilic Esophagitis in Adults

Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients

“…5,7,8 Among adults with eosinophilic esophagitis, studies report personal or family histories of allergies ranging from 50 to 90%, including up to 60% with asthma and up to 25% with food allergies. [9][10][11] A disproportionate number of our eosinophilic esophagitis patients also had asthma (at least 15%); our study may underestimate the prevalence of asthma among eosinophilic esophagitis patients, as specific reporting of allergy histories was often omitted from the clinical record.…”

“…5,9,11 Recently, Straumann et al have suggested that fragile esophageal mucosa, so-called 'crepe paper', which tears easily with minor trauma, may be pathognomic for eosinophilic esophagitis. 12 In our study, rings were more commonly reported in eosinophilic esophagitis patients vs patients with gastroesophageal reflux disease; consequently, these findings likely represent intermittent circular muscle contraction rather than true congenital rings.…”

“…Other endoscopy studies have also suggested that exudates may be less frequently seen in adults, as compared to children, with eosinophilic esophagitis. 9,11 Further studies correlating the presence of white exudates with eosinophilic microabscesses and superficially distributed eosinophils in adults with eosinophilic esophagitis are necessary to clarify the relationship between these endoscopic and histological features. As our study demonstrates, esophageal changes in eosinophilic esophagitis appear to occur in the absence of mucosal erosion or ulceration, in contradistinction to gastroesophageal reflux disease.…”

“…While many studies have used 415-20 eosinophils/hpf as a diagnostic cutoff, others have used thresholds as low as 45/hpf and as high as 430/hpf (Table 1). 5,[8][9][10][11]13 Rothenberg et al 2,14 suggest that eosinophil counts o7/hpf, 7-24/hpf and 424/hpf indicate gastroesophageal reflux disease, gastroesophageal reflux disease combined with allergy and primary eosinophilic esophagitis respectively. Although eosinophilic esophagitis patients in our study had an average of nearly 40 eosinophils/ hpf, many biopsies showed a patchy distribution and multiple hpfs within a single biopsy often lacked eosinophils.…”

Gastrointestinal Eosinophilia

“…[35] Although the incidence of primary EGID has not been rigorously calculated, a mini-epidemic of these diseases (especially EE) has been noted over the last decade. [36][37] For example, EE is a global health disease now reported in Australia, [38] Brazil, [39] England, [40] Italy, [41] Japan, [42] Spain [43][44] and Switzerland. [45] Liacouras and his group at Children's Hospital of Philadelphia have found that ∼10% of their pediatric patients with GERD-like symptoms who are unresponsive to acid blockade have EE.…”