Copyright ©2006 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 21, 2006; 12(15): 2328-2334
Published online Apr 21, 2006. doi: 10.3748/wjg.v12.i15.2328
Table 1 Clinical features of eosinophilic esophagitis
CommonDysphagiaAbdominal pain
Food impaction/foreign bodyFailure to thrive
Esophageal strictureNausea/vomitting
HeartburnFood allergy
Food allergyHeartburn
UncommonHematemesisFood impaction
Weight loss
Chest pain
Abdominal pain
Associated ConditionsHistory of atopyAsthma
AsthmaAllergic rhinitis
Allergic rhinitisEczema
Atopic dermatitis
Strong family history of atopy
Table 2 Endoscopic features of eosinophilic esophagitis
Endoscopic featureDescription
Feline esophagusMultiple concentric rings, may be fine in nature, web-like or thickened
(corrugated, ringed esophagus)
Small calibre esophagusNarrow, fixed internal diameter
Featureless, unchanging column
Poor expansion on air insufflation
Proximal and/or distal stenosis
Adherent white papulesWhite exudates 1-2 mm in diameter which do not wash off (similar to candidiasis)
Speckled patches
Loss of vascular pattern
Esophageal furrowsVertical esophageal lines
Crêpe paper mucosaFragile esophageal mucosa
Delicate, inelastic
Mucosal abrasions or tear with minimal contact
Table 3 Histopathology of eosinophilic esophagitis
GERDEosinophilic esophagitis
Eosinophilic infiltration (squamous epithelium)<10/hpf>20/HPF
Other featuresEsophagitis (usually distal)Esophagitis (proximal and/ or distal, may be patchy or segmental)
Intestinal metaplasiaBasal zone hyperplasia
Increased papillary size
Superficial eosinophilic layering or aggregates
Table 4 Differential diagnosis [40]
PrimaryIdiopathic eosinophilic esophagitis
Familial eosinophilic esophagitis
Atopic esophagitis
Secondary: Eosinophilic relatedEosinophilic gastroenteritis
Hypereosinophilic syndromes
Secondary: Non – eosinophilic relatedGERD
Recurrent vomitting
Infection (helminth, parasitic, fungal)
Esophageal GI stromal tumor
Myeloproliferative disorders
Allergic vasculitis
Table 5 Treatment regimens for eosinophilic esophagitis
Treatment optionProtocol
Elimination DietAvoidance of allergen depending on results of food allergy testing
Oligoantigenic diet: Eliminate large number of suspected foods and allow limited nutritionally balanced diet
Elemental diet: Various formulas such as Neocate (free amino acids, corn syrup solids, medium chain triglycerides)
Topical corticosteroids: Mayo Clinic protocolFluticasone 220 μg puffer 4 puffs BID x 6 wk, swallowed, no spacer
Rinse mouth with water and spit out
No food or drink for 3 h after dose
Systemic (oral) corticosteroidsMethylprednisolone 1.5 mg/kg per day (or equivalent dose prednisone)
Divide into bid dosing for 4 wk then taper over 6 wk
MontelukastInitial dose: 10 mg po daily
Titration: Dose up to 100 mg/d depending on symptoms and tolerance
Maintenance: Once symptoms relieved titrate down to minimal dose to maintain remission (usually 20 - 40 mg/d)
Mepolizumab10 mg/kg iv infusion q 4 wk x 3 doses