Eosinophilic esophagitis

Definition

  • Chronic immune mediated esophageal disease characterised by 2 clinical features
    – Symptoms of esophageal dysfunction
    – Eosinophilic predominant inflammation in esophageal mucosa
  • Must differentiate from GERD, although sometimes it’s difficult (due to PPI responsive group, see below)

Pathogenesis

  • Environemntal ?
  • Genetic ?
  • Allergic

Clinical features

  • Heartburn, dysphagia, odynophagia, reflux
  • History of allergy/atopic disorders is common in these patients

Complication

  • Malnutrition
  • Stricture
  • Rarely perforation

Diagnosis

  • By endscopy and biopsy
  • Endoscopy findings: classical is trachealization of esophagus (esophageal rings)
  • Biopsy will show eosinophils in esophageal mucosa

Treatment

  • Diet: avoid food that can cause allergy
    – Most often this is difficult to be known, so can adapt 6 foods eliminated diet (foods that most commonly will cause allergy i.e wheat, milk, eggs, seafood, soy and nuts) OR allergy testing based (food eliminated by skin prick testing/RAST)
  • PPI?
    – PPI non responsive was thought to be definitive in ruling out GERD.
    – However, there is a subset of patients with eosinophilic esophagitis who may respond to PPI (PPI responsive eosinophilic esophagitis)
    ** May be due to concurrent GERD or PPI may decrease cytokine release from esophageal epithelium
  • Topic glucocorticoids
    – Key in treatment of eosinophilic esophagitis
    – 
    MDI containing budesonide OR oral viscous fluticasone (oral form has been shown to be more effective due to longer contact with mucosa)

Reference

  • Glenn T.Furuta M.D. and David A.Katzka M.D. Eosinophilic Esophagitis. N Eng J Med 2015;373:1640-8
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s