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Review
. 2019 Jan;103(1):29-42.
doi: 10.1016/j.mcna.2018.08.009. Epub 2018 Nov 1.

Eosinophilic Esophagitis

Craig C Reed  1 , Evan S Dellon  2
Affiliations
Review

Eosinophilic Esophagitis

Craig C Reed et al. Med Clin North Am. 2019 Jan.

Abstract

Eosinophilic esophagitis (EoE) is a chronic disorder characterized by symptoms of esophageal dysfunction and esophageal inflammation with intraepithelial eosinophils. EoE represents an important cause of upper gastrointestinal morbidity. Primary care providers are pivotal for timely and accurate recognition of symptoms of eosinophilic esophagitis, for facilitating diagnoses through specialist referrals, and for understanding management strategies. This process begins with a thorough understanding of the clinical features of EoE, its associated atopic conditions, and its evolving epidemiology.

Keywords: Dysphagia; Eosinophilic esophagitis; Food bolus impaction; Heartburn.

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Conflict of interest statement

Potential competing interests: None of the authors report any potential conflicts of interest with this paper. Dr. Dellon is a consultant for Adare, Alivio, Banner, Enumeral, GSK, Receptos/Celegene, Regeneron, and Shire, receives research funding from Adare, Meritage, Miraca, Nutricia, Receptos/Celgene, Regeneron, and Shire, and has received educational grants from Banner and Holoclara.

Figures

Figure 1
Figure 1
Endoscopic images of EoE. (A) The endoscopic appearance of the normal esophagus. Note the uniform and smooth appearance of the esophageal mucosa, with the fine vascular pattern clearly visible. (B) An EoE patient with evidence of esophageal rings, furrows, edema, and exudates. (C) An EoE patient with esophageal edema, deep furrows, and mild exudates. (D) An EoE patient with a focal stricture, in addition to mild rings, furrows, edema, and exudates. (E) Esophageal biopsy underway. (F) An EoE patient with a very narrow caliber esophagus and tight rings, as well as edema, after esophageal dilation. Good dilation effect (mucosal rent) is seen in the 11 o’clock position.
Figure 2
Figure 2
Histologic image of an esophageal biopsy in EoE. In addition to the prominent eosinophilic infiltration (>15 eos/hpf), there is eosinophil degranulation, basal zone hyperplasia, and spongiosis.
Figure 3
Figure 3
Treatment algorithm for the primary and secondary treatment of eosinophilic esophagitis.
See this image and copyright information in PMC

References

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