Eosinophilic esophagitis (EoE) may affect individuals at any age with a predominance for Caucasian males. The clinical manifestation of EoE is strongly age dependent. While dysphagia and food impaction are typical lead symptoms in adults and adolescents, infants often present with unspecific symptoms such as feeding problems, abdominal pain and vomiting. Some EoE patients may also experience heartburn. Therefore, EoE should always be considered in cases of heartburn refractory to antireflux therapy. Concomitant allergic diseases such as asthma, rhinitis and eczema are prevalent. Peripheral eosinophilia and elevated total serum IgE values are found in up to 50 and 70% of cases, respectively. Endoscopic features of EoE are variable and none of them is pathognomonic. Frequent findings are mucosal edema, furrows, exudates and corrugated rings. These endoscopic abnormalities have high specificities (90-95%), but low sensitivities (15-48%). A novel grading and classification system for the endoscopic assessment of EoE has been proposed which includes fixed rings, exudates, furrows and edema as major features. This classification system demonstrated good interobserver agreement among pediatric and adult gastroenterologists, and presents a useful tool to standardize endoscopic assessments and to further investigate the relation between endoscopic manifestation, clinical activity and response to treatment in EoE. Long-term follow-up studies have shown that EoE is a chronic disease causing recurrent dysphagia in the majority of cases. The prevalence of strictures significantly increases with the duration of disease, which stresses the importance of early diagnosis and consequent treatment of EoE.

Keywords:
Eosinophilic esophagitis, Dysphagia, Bolus obstruction, Endoscopy
1.
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil BK, Rothenberg ME, Aceves SS: Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20.
2.
Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, Locke GR 3rd, Talley NJ: Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 2009;7:1055-1061.
3.
Kapel RC, Miller JK, Torres C, Aksoy S, Lash R, Katzka DA: Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology 2008;134:1316-1321.
4.
Hruz P, Straumann A, Bussmann C, Heer P, Simon HU, Zwahlen M, Beglinger C, Schoepfer AM, Swiss EoE Study Group: Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol 2011;128:1349-1350.
5.
Straumann A, Aceves SS, Blanchard C, Collins MH, Furuta GT, Hirano I, Schoepfer AM, Simon D, Simon HU: Pediatric and adult eosinophilic esophagitis: similarities and differences. Allergy 2012;67:477-490.
6.
Lucendo AJ, Sánchez-Cazalilla M: Adult versus pediatric eosinophilic esophagitis: important differences and similarities for the clinician to understand. Expert Rev Clin Immunol 2012:8:733-745.
7.
Veerappan GR, Perry JL, Duncan TJ, Baker TP, Maydonovitch C, Lake JM, Wong RK, Osgard EM: Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study. Clin Gastroenterol Hepatol 2009;7:420-426.
8.
Prasad GA, Talley NJ, Romero Y, Arora AS, Kryzer LA, Smyrk TC, Alexander JA: Prevalence and predictive factors of eosinophilic esophagitis in patients presenting with dysphagia: a prospective study. Am J Gastroenterol 2007;102:2627-2632.
9.
Katzka DA: Demographic data and symptoms of eosinphilic esophagitis in adults. Gastrointest Endosc Clin N Am 2008;18:25-32.
10.
Sperry SL, Crockett SD, Miller CB, Shaheen NJ, Dellon ES: Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis. Gastrointest Endosc 2011;74:985-991.
11.
Miehlke S, Alpan O, Schröder S, Straumann A: Induction of eosinophilic esophagitis by sublingual pollen immunotherapy. Case Rep Gastroenterol 2013;7:363-368.
12.
Liacouras CA, Spergel JM, Ruchelli, et al: Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005;3:1198-1206.
13.
Gonsalves N, Yang GY, Doerfler B, Ritz S, Ditto AM, Hirano I: Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology 2012;142:1451-1459.
14.
Miehlke S, Hruz P, von Arnim U, Madisch A, Vieth M, Bussmann C, Bajbouj M, Fibbe C, Wittenburg H, Allescher HD, Reinshagen M, Schubert S, Tack J, Mueller R, Dilger K, Greinwald R, Straumann A: Two new budesonide formulations are highly efficient for treatment of active eosinophilic esophagitis: results from a randomized, double-blind, double-dummy, placebo-controlled multicenter trial. DDW 2014, accepted.
15.
Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU: Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 2003;125:1660-1669.
16.
Schoepfer AM, Safroneeva E, Bussmann C, Kuchen T, Portmann S, Simon HU, Straumann A: Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation, in a time-dependent manner. Gastroenterology 2013;145:1230-1236.e2.
17.
Müller S, Pühl S, Vieth M, Stolte M: Analysis of symptoms and endoscopic findings in 117 patients with histological diagnosis of eosinophilic esophagitis. Endoscopy 2007;39:339-344.
18.
Kwiatek MA, Hirano I, Kahrilas PJ, Rothe J, Luger D, Pandolfino J: Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology 2011;140:82-90.
19.
Roman S, Hirano I, Kwiatek MA, Gonsalves N, Chen J, Kahrilas PJ, Pandolfino JE: Manometric features of eosinophilic esophagitis in esophageal pressure topography. Neurogastroenterol Motil 2011;23:208-214.
20.
Molina-Infante J, Ferrando-Lamana L, Ripoll C, Hernandez-Alonso M, Mateos JM, Fernandez-Bermejo M, Dueñas C, Fernandez-Gonzalez N, Quintana EM, Gonzalez-Nuñez MA: Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults. Clin Gastroenterol Hepatol 2011;9:110-117.
21.
von Arnim U, Wex T, Röhl FW, Neumann H, Küster D, Weigt J, Mönkemüller K, Malfertheiner P: Identification of clinical and laboratory markers for predicting eosinophilic in adults. Digestion 2011;84:323-327.
22.
Roy-Ghanta, Larosa DF, Katzka DA: Atopic characteristics of adult patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2008;6:531-535.
23.
Simon D, Marti H, Heer P, Simon HU, Braathen LR, Straumann A: Eosinophilic esophagitis is frequently associated with IgE-mediated allergic airway diseases. J Allergy Clin Immunol 2005;115:1090-1092.
24.
Lucendo AJ, Arias A, Gonzalez-Cervera J, Yague-Compadre JL, Guagnozzi D, Angueira T, Jimnez-Contreras S, Gonzalez-Castillo S, Rodrıguez-Domıngez B, De Rezende LC, Tenias JM: Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy Clin Immunol 2013;131:797-804.
25.
DeBrosse CW, Franciosi JP, King EC, et al: Long-term outcomes in pediatric onset esophageal eosinophilia. J Allergy Clin Immunol 2011;128:132-138.
26.
Taft TH, Kern E, Kwiatek MA, Hirano I, Gonsalves N, Keefer L: The adult eosinophilic oesophagitis quality of life questionnaire: a new measure of health-related quality of life. Aliment Pharmacol Ther 2011;34:790-798.
27.
Harris RF, Menard-Katcher C, Atkins D, Furuta GT, Klinnert MD: Psychosocial dysfunction in children and adolescents with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2013;57:500-505.
28.
Straumann A, Spichtin HP, Bucher KA, Heer P, Simon HU: Eosinophilic esophagitis: red on microscopy, white on endoscopy. Digestion 2004;70:109-116.
29.
Kim HP, Vance RB, Shaheen NJ, Dellon ES: The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol 2012;10:988-996.
30.
Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR: Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013;62:489-495.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.