Clinical Presentation and Approach to Dietary Management of Eosinophilic Esophagitis

Abstract

Eosinophilic gastrointestinal disorders are a group of disorders that are characterized by chronic eosinophilic inflammation in the gastrointestinal tract, leading to organ dysfunction and clinical symptoms. The disorders are considered immune-mediated and inflammatory, with strong associations to food allergy triggers. The most common eosinophilic gastrointestinal disorder is eosinophilic esophagitis (EoE), which usually presents with dysphagia and food impaction in adults and with heartburn, abdominal pain, and vomiting in children. Treatment strategies consist of medical and dietary therapies. In addition to the clinical presentation of EoE, this article focuses on dietary management, which includes controlling symptoms and bowel inflammation as well as identifying potential food triggers to help tailor a diet for long-term disease management.

Keywords: Eosinophilic esophagitis; dysphagia; food allergy; food impaction.

Figure 1.

Endoscopic images illustrating concentric mucosal rings (A), linear furrows (B), white plaques (C), and food impaction (D), all common features of eosinophilic esophagitis in adults.

Figure 2.

Histologic features in a patient with eosinophilic esophagitis show numerous eosinophils with superficial layering in the esophageal epithelium (large arrow), intercellular edema or spongiosis (small arrow), and microabscesses or clusters of 4 or more eosinophils in a group (star).