II. Pathophysiology

  1. Immune-mediated esophagitis ("Asthma of the esophagus")

III. Symptoms: Teens and Adults

  1. Solid Dysphagia
  2. Food impaction (associated with Esophageal Strictures in up to 31%)
  3. Central Chest Pain refractory to Antacids
  4. Refractory GERD
  5. Upper abdominal (Epigastric Pain)

IV. Symptoms: Younger Children

  1. Feeding dysfunction
  2. Vomiting
  3. Abdominal Pain

V. Associated Conditions: Allergic Disorders

  1. Asthma
  2. Atopic Dermatitis
  3. Food Allergies
  4. Gluten Sensitive Enteropathy
  5. Environmental Allergies

VI. Diagnosis

  1. Upper Endoscopy with biopsy

VII. Differential Diagnosis

VIII. Management

  1. Manage as Gastroesophageal Reflux disease initially (prior to diagnosis by endoscopy and biopsy)
    1. Proton Pump Inhibitor
    2. GERD precautions (avoiding Alcohol, Tobacco, Caffeine, food within 2 hours of lying supine)
  2. Avoid possible food triggers
    1. Consider avoiding milk, wheat, eggs, soy, nuts and seafood
  3. Inhaled Corticosteroids (e.g. Flovent HFA, budesonide) swallowed instead of inhaled
    1. Use Metered Dose Inhalers (not Dry Powder Inhalers)
    2. Puff the Inhaler within the mouth without inspiring, and then swallow the medication
      1. Alternatively, may mix budesonide nebules with Splenda and swallow
    3. Rinse mouth of steroid, but do not swallow water, other liquid or solid for at least 30 minutes
  4. Biologic agents
    1. Interleukin-4 Alpha Receptor Antagonist: Dupilumab (Dupixent)

IX. References

  1. Bonis and Furuta (2017) ...Eosinophilic Esophagitis, UpToDate, Wolters Kluwer, accessed 11/4/2017
  2. (2017) Presc Lett 24(11): 65

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Related Studies

Ontology: Eosinophilic esophagitis (C0341106)

Definition (MSH) Chronic ESOPHAGITIS characterized by esophageal mucosal EOSINOPHILIA. It is diagnosed when an increase in EOSINOPHILS are present over the entire esophagus. The reflux symptoms fail to respond to PROTON PUMP INHIBITORS treatment, unlike in GASTROESOPHAGEAL REFLUX DISEASE. The symptoms are associated with IgE-mediated hypersensitivity to food or inhalant allergens.
Definition (NCI) Allergic inflammation of the esophagus. Morphologically, it is characterized by the presence of eosinophils infiltrating the esophageal epithelium. Patients present with swallowing difficulty and heartburn.
Concepts Disease or Syndrome (T047)
MSH D057765
ICD9 530.13
ICD10 K20.0
SnomedCT 235599003
Dutch eosinofiele oesofagitis
French Oesophagite eosinophilique, Oesophagite à éosinophiles, Oesophagite éosinophilique, OE (Oesophagite à Éosinophiles)
Portuguese Esofagite eosinófila, Esofagite Eosinofílica
Spanish Esofagitis eosinofílica, Esofagitis Eosinofílica, esofagitis eosinofílica (trastorno), esofagitis eosinofílica
Italian Flogosi eosinofila dell'esofago, Esofagite eosinofila
Japanese 好酸球性食道炎, コウサンキュウセイショクドウエン
English Eosinophilic esophagitis, eosinophilic esophagitis, eosinophilic esophagitis (diagnosis), Chronic Esophagitides, Eosinophilic, Esophagitides, Eosinophilic, Eosinophilic Chronic Esophagitis, Eosinophilic Esophagitis, Eosinophilic Esophagitides, Esophagitides, Eosinophilic Chronic, Esophagitis, Eosinophilic Chronic, Chronic Esophagitis, Eosinophilic, Eosinophilic Chronic Esophagitides, eosinophilic oesophagitis, Eosinophilic Esophagitis [Disease/Finding], ESOPHAGITIS, EOSINOPHILIC, ESOPHAGITIS, EOSINOPHILIC, 1, EE, EOE1, Esophagitis, Eosinophilic, Eosinophilic oesophagitis, Eosinophilic esophagitis (disorder)
Czech Eozinofilní ezofagitida, Eozinofilní esofagitida, chronická eozinofilní ezofagitida, eozinofilní ezofagitida
German Eosinophile Oesophagitis, Chronische Speiseröhrenentzündung, eosinophile, Eosinophile Speiseroehrenentzuendung, Chronische Speiseroehrenentzuendung, eosinophile, Eosinophile Ösophagitis, Eosinophile Speiseröhrenentzündung, eosinophile Oesophagitis
Hungarian Eosinophiliás oesophagitis, Eosinophiliás nyelőcsőgyulladás
Polish Eozynofilowe zapalenie przełyku, Zapalenie przełyku eozynofilowe
Norwegian Eosinofil øsofagitt, Kronisk eosinofil øsofagitt, Eosinofil spiserørsbetennelse