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Eosinophilic Esophagitis
Aka: Eosinophilic Esophagitis, Chronic Eosinophilic Esophagitis
- Pathophysiology
- Immune-mediated esophagitis ("Asthma of the esophagus")
- Symptoms: Teens and Adults
- Solid Dysphagia
- Food impaction (associated with Esophageal Strictures in up to 31%)
- Central Chest Pain refractory to Antacids
- Refractory GERD
- Upper abdominal (Epigastric Pain)
- Symptoms: Younger Children
- Feeding dysfunction
- Vomiting
- Abdominal Pain
- Associated Conditions: Allergic Disorders
- Asthma
- Atopic Dermatitis
- Food Allergies
- Gluten Sensitive Enteropathy
- Environmental Allergies
- Diagnosis
- Upper Endoscopy with biopsy
- Differential Diagnosis
- See Vomiting
- Gastroesophageal Reflux Disease
- Esophageal Dysmotility
- Inflammatory Bowel Disease
- Esophageal Cancer
- Parasitic Infection
- Other esophagitis (e.g. candidal esophagitis)
- Management
- Manage as Gastroesophageal Reflux disease initially (prior to diagnosis by endoscopy and biopsy)
- Proton Pump Inhibitor
- GERD precautions (avoiding Alcohol, Tobacco, Caffeine, food within 2 hours of lying supine)
- Avoid possible food triggers
- Consider avoiding milk, wheat, eggs, soy, nuts and seafood
- Inhaled Corticosteroids (e.g. Flovent HFA, budesonide) swallowed instead of inhaled
- Use Metered Dose Inhalers (not Dry Powder Inhalers)
- Puff the Inhaler within the mouth without inspiring, and then swallow the medication
- Alternatively, may mix budesonide nebules with Splenda and swallow
- Rinse mouth of steroid, but do not swallow water, other liquid or solid for at least 30 minutes
- References
- Bonis and Furuta (2017) ...Eosinophilic Esophagitis, UpToDate, Wolters Kluwer, accessed 11/4/2017
- (2017) Presc Lett 24(11): 65