Eosinophilic Esophagitis- Clinical Management in Adults

Abstract

Eosinophilic esophagitis (EoE) represents a chronic, immune-mediated esophageal disease, characterized clinically by symptoms related to esophageal dysfunction, histologically by eosinophilic infiltration of esophageal mucosa and endoscopically by a range of abnormalities. EoE is increasing in prevalence and predominantly affects children and young males, with a racial predilection of the patients being Caucasian. The relationship between EoE and gastroesophageal reflux disease (GERD) can be complex, since their clinical and pathologic features may overlap. Furthermore, an entity that can be considered a subtype of GERD or EoE is the proton pump inhibitorresponsive esophageal eosinophilia (PPI-REE). PPI-REE emerged from the observation that some patients who appeared to have EoE would have a clinical and histologic response to PPI treatment. Currently, upper endoscopy with esophageal biopsies is the only way to diagnose EoE. Fifteen eosinophils//high-power field (hpf) are considered a minimum threshold for the diagnosis of EoE, since the disease is isolated to the esophagus and other causes of esophageal eosinophilia are excluded. Patients commonly have concurrent allergic diatheses, especially to food. The therapeutic options of EoE include: chronic elimination diet, topical corticosteroids and esophageal dilation. We review the latest approach to clinical diagnosis and management of EoE.