Respiratory symptoms associated with eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EoE) is an atopic condition diagnosed based on eosinophilic infiltration in the esophagus and symptoms of esophageal dysfunction. Typical clinical manifestations of EoE include feeding refusal, vomiting, and dysphagia however recent reports highlight an associations with extraesophageal symptoms. By definition the inflammatory response in EoE is restricted to the esophagus. However, accounts of symptoms such as chronic refractory cough, recurrent croup, hoarseness as well as subglottic stenosis, and an increase in otolaryngologic surgeries in patients with EoE raise the possibility of extraesophageal manifestations of the disease. These symptoms have been reported at times in the absence of typical gastrointestinal symptoms. While the condition is usually managed by gastroenterologist and/or allergist, the presence of extraesophageal symptoms and comorbid conditions may result in patients presenting initially to providers in other subspecialties such as pulmonology and otorhinolaryngology. The use of proton pump inhibitors and corticosteroids are part of the management of EoE. Awareness of the possibility of EoE before the empiric use of these therapies is important as there use can make identifying and diagnosing patients with EoE correctly challenging. We review the medical literature regarding extraesophageal manifestations of EoE and highlight the importance of awareness for subspecialist outside of gastroenterology and allergy for the condition.

Keywords: Eosinophilic esophagitis; cough; endoscopy; esophagitis; proton pump inhibitors.