Diagnosis and treatment of eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EoE) is an eosinophil-rich, T_H2 antigen-mediated disease of increasing pediatric and adult worldwide prevalence. Diagnosis requires greater than or equal to 15 eosinophils per high-power field on light microscopy. Symptoms reflect esophageal dysfunction, and typical endoscopic features include linear furrows, white plaques, and concentric rings. Progressive disease leads to pathologic tissue remodeling, with ensuing esophageal rigidity and loss of luminal diameter caused by strictures. Therapies include proton pump inhibitors, elimination diets, and topical corticosteroids. Effective treatment can reverse tissue fibrosis in some patients, as well as decrease the rate of food impactions. Esophageal dilation might be required to increase luminal patency. The chronic nature of EoE necessitates long-term therapy to avoid disease recurrence and complications. This review serves the function of providing the current state-of-the-art diagnostic criteria and disease management for adult and pediatric EoE.

Keywords: Eosinophil; corticosteroid; diet; dysphagia; fibrosis; remodeling; stricture.

Figure 1:

Suggested algorithm for EoE management. *See Dellon and Hirano article in this issue for further information on emerging biologic therapy.