Eosinophilic oesophagitis

What is it?

Eosinophilic esophagitis is a chronic immune-mediated esophageal disease that is characterized clinically by symptoms associated with esophageal dysfunction and histologically by a predominantly eosinophilic inflammatory infiltrate. It is a rare disease, with an estimated prevalence of 55/100000 individuals. It mainly affects men in the second and third decades of life and is closely related to various allergic diseases such as food and environmental allergies, asthma and atopic dermatitis.

Which are the symptoms?

The clinical manifestations of eosinophilic esophagitis depend on age. In adults, it most commonly manifests as dysphagia and swallowing of food bolus, whereas in children the most frequent symptoms are difficulty in feeding, gastroesophageal reflux symptoms and abdominal pain. If delayed diagnosis, chronic inflammation can lead to progressive tissue fibrosis and subsequent development of esophageal stenosis.

  • Dysphagia
  • Bolus impaction
  • Chest pain
  • Reflux-like symptoms
  • Pain in epigastric region
  • Difficulty in feeding
  • Vomiting
  • Abdominal pain

How is it diagnosed?

The diagnosis of eosinophilic esophagitis is based on symptoms, endoscopic and histological evaluation. In particular, the first examination to be performed in case of clinical suspicion is esophagogastroduodenoscopy with biopsy of the esophagus. Biochemical and radiological examinations can provide useful diagnostic support, although they are not always necessary for a definitive diagnosis. In particular, diagnostic criteria include: symptoms associated with esophageal dysfunction, histological confirmation of a predominantly eosinophilic infiltrate on esophageal biopsy with ≥15 eosinophils per microscopic field or ≥60 eosinophils per mm2 , and exclusion of other causes potentially responsible for symptoms or esophageal eosinophilic infiltrate.

Suggested exams

How is it treated?

Treatment of eosinophilic esophagitis is multidisciplinary and includes dietary, pharmacological and endoscopic therapy. Diet, elemental or elimination, is the first-line approach for both adult and paediatric patients, given the close association between this disease and food allergy, and should be undertaken by a specialist dietitian. The pharmacological approach includes proton pump inhibitors (PPIs) and, if symptoms persist, topical corticosteroids, including budesonide and fluticasone. The aim of treatment includes both clinical and histological remission. Endoscopic dilatation therapy is given only in cases of developing oesophageal stenosis. Clinical trials are underway to evaluate the use of new drugs, including biological agents, immunosuppressants and leukotriene inhibitors.

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