Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults

Abstract

Objective: To describe the clinical features of patients with eosinophilic esophagitis and the use of topical corticosteroids for treatment.

Patients and methods: We evaluated the charts of 21 patients with a diagnosis of eosinophilic esophagitis seen at the Mayo Clinic in Rochester, Minn, between September 1, 1999, and December 31, 2001. The diagnosis was based on the presence of a "ringed esophagus" or a tapered distal esophagus on upper endoscopy as well as the presence of a dense eosinophilic infiltrate on esophageal biopsy. All patients were treated with topical corticosteroids, and follow-up was performed by telephone interviews.

Results: The 15 men and 6 women ranged in age from 27 years to 66 years at diagnosis (mean, 36 [corrected] years). All had solid-food dysphagia for at least 6 years, and 15 patients had prior food impaction. Eighteen patients had either a ringed-appearing esophagus or smooth tapering in the distal esophagus. All patients had a dense eosinophilic infiltration (> 20 eosinophils per high-power field) in the mid or distal esophagus. Topical corticosteroid therapy for 6 weeks resulted in complete dysphagia relief in all patients and lasted a minimum of 4 months.

Conclusion: Eosinophilic esophagitis is an entity associated with food dysphagia (predominantly in young adults) and a ringed or smooth tapered distal-appearing esophagus. Our study found no association with gastroesophageal reflux symptoms. Topical corticosteroid therapy was effective.