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Eosinophilic Esophagitis
Allergic Esophagitis


General Considerations

  • Can occur at any age but has more often been reported in children
  • More common in males
  • Prevalence appears to be increasing
  • Often occurs in association with asthma, eczema, chronic rhinitis and family history of atopy
  • Believed secondary to contact sensitivity with mucosa
    • Cow's milk protein is most common but soy, egg and wheat have also been implicated
  • Biopsy shows marked (>15-20 eosinophils) eosinophilic infiltration of epithelium

Clinical Findings

  • Intermittent dysphagia
  • Heartburn
  • Food impaction (common presentation in adults especially)
  • Chest pain
  • Older children may demonstrate vomiting, regurgitation epigastric and chest pain

Imaging Findings

  • Barium swallow is usually the initial study in workup but the findings are not pathognomonic
  • Featureless small-caliber esophagus
    • Entire esophagus may be narrowed and difficult to appreciate radiologically
  • Focal esophageal narrowing
  • Ringed esophagus
  • The narrowing tends to occur more proximal than with GERD
  • Corrugated esophagus with multiple concentric mucosal rings
  • Small caliber of esophageal lumen
  • Requires biopsy for diagnosis

Differential Diagnosis

  • Gastro-esophageal reflux (GERD)
  • Schatzki's ring
  • Corrosive esophagitis
  • Infectious esophagitis
  • Radiation-induced

Treatment

  • Fails to respond to usual treatment for GERD
  • Controversial
    • Removal of food allergen
    • Oral corticosteroids treat symptoms but they tend to recurs when treatment is stopped

Complications

  • Stricture formation
  • Can be part of eosinophilic gastroenteritis

Prognosis

  • Long-term outcome studies are not available yet

Eosinophilic Esophagitis. There is persistent narrowing of the distal esophagus with smooth borders and no overhanging edge. The finding is not specific for eosinophilic esophagitis, which requires biopsy for diagnosis, but should be consider in a younger patient with a history of allergies or asthma.
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Eosinophilic esophagitis, GI Motility online (2006), Samuel Nurko and Glenn T. Furuta

Esophagitis, eMedicine: Jessica Wen, Andrew S Chu, Maria Rebello Mascarenhas