Eosinophilic esophagitis

Czech version

Authors: A. Štrosová ¹; J. Martínek ¹; Š. Suchánek ¹; F. Závada ¹; M. Stefanová ¹; B. Bunganič ¹; I. Tučková ²; P. Hrabal ²; M. Zavoral ¹
Authors‘ workplace: Interní klinika 1. LF UK a ÚVN Praha ¹; Oddělení patologie, ÚVN Praha ²
Published in: Gastroent Hepatol 2011; 65(5): 272-278
Category: Clinical and Experimental Gastroenterology: Review Article

Overview

The article summarizes the “state of the art” concerning eosinophilic esophagitis and describes the results of our own prospective study. Eosinophilic esophagitis (EoE) is a rare and not very often diagnosed esophageal disorder. It is caused by chronic infiltration of the esophageal mucosa by eosinophils and it has typical clinical, endoscopic and histopathologic manifestations. EoE was firstly described in 1978. Traditionally, the definition of EoE has been set on the basis of an arbitrary limit of eosinophils (usually ≥ 15 eosinophils / high power field) in patients with typical symptomatology and without pathological gastroesophageal reflux (defined as negative pH-metry or by the absence of a clinical improvement during treatment with a proton pump inhibitor). Now, a new definition of EoE is being proposed where patients with gastroesophageal reflux and eosinophilic infiltration of the esophagus should also get a diagnosis of EoE. Furthermore, patients with EoE must not have eosinophilic infiltration in any of the remaining parts of the GIT. Patients with EoE usually complain about dysphagia and food impaction. The etiology and the prognosis are not clearly established. EoE’s course is usually chronic. Long lasting inflammation in the esophagus leads to changes of the esophageal wall and mucosa which become rigid as well as fragile. Therefore, mucosal lacerations or even perforations can easily occur. A risk of malignancy in patients with EoE has not yet been described and seems unlikely. EoE is detected in patients of all ages, including children with males predominating. An association with different kinds of allergies is typical. As an initial treatment option, a proton pump inhibitor is administered, and if necessary, corticosteroids (locally or systemic administration) are given. Other treatment modalities are rather experimental and are being tested in clinical trials (e.g. biologic therapy). Endoscopic dilatation is a treatment option for symptomatic patients with narrow or stenotic esophageal lumen. The prevalence of esophageal eosinophilia was 5.6% among patients referred for upper GI endoscopy. A majority of patients with eosinophils (> 15/HPF) were diagnosed with EoE. However, a high number of eosinophils was also observed in two patients with achalasia and in one patient with Barrett’s esophagus. In accordance with other authors, we confirmed the majority of patients with EoE presents with dysphagia/food impaction (90%), while an allergy was present in 50% of our patients. Almost all patients responded favourably to treatment with a proton pump inhibitor.

Key words:
eosinophilic esophagitis – dysphagia – reflux esophagitis – esophageal perforation

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