Eosinophilic Esophagitis

Abstract

Once considered a rare condition, eosinophilic esophagitis is now one of the most common conditions diagnosed during the assessment of feeding problems in children and during the evaluation of dysphagia and food impaction in adults. The entity exists worldwide but has been most extensively studied in Western countries, where its prevalence has been estimated to be 0.4% among all children and adults. Whether eosinophilic esophagitis is truly a new disease or simply a recently recognized one is uncertain. In this review, we consider the diagnostic criteria, pathophysiological and clinical features, and treatment of this increasingly prevalent disease.

Figure 1. Pathophysiological Mechanisms of Eosinophilic Esophagitis

Eosinophilic esophagitis is an allergen-mediated disease in which eosinophils are recruited to the esophagus. The functional consequences of this inflammation include stricture formation with proximal dilatation and longitudinal shearing. CCL26 denotes chemokine C–C motif ligand 26, TGF transforming growth factor, Th1 type 1 helper T cell, Th2 type 2 helper T cell, and TSLP thymic stromal lymphopoietin.

Figure 2. Histologic Characteristics of Eosinophilic Esophagitis

Routine staining with hematoxylin and eosin reveals numerous eosinophils (thin arrows), dilated intercellular spaces (thick arrow), basal zone hyperplasia (circle), and papillary elongation (bracket).