- 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)
- Environemntal ?
- Genetic ?
- Heartburn, dysphagia, odynophagia, reflux
- History of allergy/atopic disorders is common in these patients
- Rarely perforation
- By endscopy and biopsy
- Endoscopy findings: classical is trachealization of esophagus (esophageal rings)
- Biopsy will show eosinophils in esophageal mucosa
- 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 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)
- Glenn T.Furuta M.D. and David A.Katzka M.D. Eosinophilic Esophagitis. N Eng J Med 2015;373:1640-8