Eosinophilic esophagitis -- clinical manifestations, diagnosis, and treatment

ABSTRACT

Eosinophilic esophagitis (EE) is a chronic inflammatory, immunoallergicdisease of the esophagus that represents the mostcommon eosinophilic gut disease. Understanding and diagnosisregarding this condition have greatly increased in recent years,particularly in Europe and North America, in parallel with otherallergic disorders. It consists of dense esophageal infiltrationwith eosinophils in the absence of gastro-esophageal reflux(GER). It involves individuals at all ages, and is particularly commonin males during childhood and up to the 5th decade of life.It manifests with chronic, intermittent esophageal symptomsthat predominantly include dysphagia, food impactionepisodes, and GER-attributable complaints that do not respondto antisecretory therapy.Endoscopically, EE is a polymorphous disease that presentswith various changes in esophageal caliber, and subtle changesin mucosal appearance, which lead to biopsy collection as a keyprocedure for diagnosis. Management must be multidisciplinary,including gastroenterologists, pathologists, allergologists,and also nutrition specialists in pediatric cases.Regarding therapy, dietary food restrictions are especiallyuseful in the management of pediatric EE, but effectiveness islower in the adult, maybe because of a greater involvement ofair allergens. Drug use is standard, particularly involving topicalsteroids, which may revert manifestations and histological lesions,even though recurrence following discontinuation is common(AU)