Eosinophilic Esophagitis: an Emerging Clinicopathologic Disease of Children and Adults

Abstract

Eosinophililc esophagitis is a clinicopathologic disease characterized clinically by dysphagia and food impaction in adults and nonspecific symptoms of gastroesophageal reflux disease in children, and histologically by large numbers of eosinophils in the proximal and distal esophageal epithelium. Importantly, these symptoms and histologic abnormalities appear to be unresponsive to proton pump inhibition. Recent clinical and basic studies suggest an allergic etiology but the precise allergen remains unknown and is likely unique for each patient. Endoscopic features suggest ongoing inflammation and range from linear furrowing with whitish exudation to long-segment stricture formation, to a fragile, crepe paper-like mucosa that is easily split open. Treatments include nutritional restrictions, medical management with topical steroids, and, in stenotic circumstances, esophageal dilation. The long-term outcome is still not certain.

Keywords: Eosinophil; allergic esophagitis; dysphagia; esophageal stricture; food impaction; interleukin-5.

Figure 1.

Endoscopic pictures of the esophagus of a 40-year-old male patient with eosinophilic esophagitis, demonstrating prominent white exudates (A), red furrows (B), and corrugated rings (C). The patient has experienced dysphagia for 9 years.

Figure 2.

Photomicrograph of the esophageal mucosa from a 60-year-old female patient with eosinophilic esophagitis. Note the dense eosinophilic infiltration of the superficial layers of the squamous epithelium (HE staining; original magnification 400×).