Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Apr 21, 2006; 12(15): 2328-2334
Published online Apr 21, 2006. doi: 10.3748/wjg.v12.i15.2328
Eosinophilic esophagitis: A newly established cause of dysphagia
Brian M Yan, Eldon A Shaffer
Brian M Yan, Eldon A Shaffer, Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Correspondence to: Dr. Eldon A Shaffer, Rm G163, UCMC Health Sciences Centre, Division of Gastroenterology, Faculty of Medicine, University of Calgary,3330 Hospital Drive N.W.,Calgary, Alberta, T2N - 4N1, Canada.
Telephone: +1-40-32109363 Fax: +1-40-32109368
Received: November 16, 2005
Revised: December 2, 2005
Accepted: December 7, 2005
Published online: April 21, 2006

Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/105 in children and 2.5/105 in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a “feline” or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accep-ted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.

Keywords: Eosinophilic esophagitis, Allergy, Dysphagia