Eosinophilic Esophagitis

2007-06-18T14:59:00.000-07:00

Eosinophilic Esophagitis
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Endoscopic image of esophagus in a case of eosinophilic esophagitis. Concentric rings are termed trachealization of the esophagus.

Barium swallow of the esophagus, showing multiple rings associated with eosinophilic esophagitis.

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H&E stain of esophagus biopsy showing eosinophilic esophagitis, manifested by an infiltration of eosinophils in the lamina propria

Eosinophilic esophagitis is an allergic inflammatory condition of the esophagus. Symptoms are chest pain or heartburn and occasionally dysphagia, or difficulty in swallowing. The disease was first described in children but occurs in adults as well.

Diagnosis is obtained during an upper GI endoscopy where biopsies are taken of the esophagus. At the time of endoscopy, ridges or furrows may be seen in the esophagus wall. Sometimes, multiple rings may occur in the esophagus, leading to the term "multi-ring esophagus" or "feline esophagus" due to the similarity in the rings of the cat esophagus. A high number of eosinophils are seen on microscopic examination of the biopsy specimens. Skin testing can help identify which foods might contribute to this disease, but often skin testing implicates foods that are not involved. Common allergens in the GI tract are cow's milk, soy, egg and wheat.
Treatment strategies include removal of the offending food, proton pump inhibitors to decrease acidity in the stomach that may reflux into the esophagus, inhaled steroid puffers taken orally and swallowed, anti-histamines, H2-receptor blockers such as cimetidine, leukotriene modifiers such as montelukast, and, in investigational reports, the anti-IL5 monoclonal antibody mepolizumab. Refractory patients may require oral steroid medications.

External links
American Partnership for Eosinophilic Disorders
Cincinnati Center for Eosinophilic Disorders

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