Eosinophilic esophagitis as the main cause of dysphagia in adults?

Eosinophilic oesophagitis (EoE) was first described in the early 1990s, and was considered rare in adults. Since then, it has rapidly evolved as a distinctive chronic inflammatory oesophageal disease with increasing incidence and prevalence in the westernized countries.

Currently, EoE represents the main cause of dysphagia in adult patients (according to the review authors). This disease is more prevalent in males and is frequently associated with allergies.

Diagnosis

The diagnosis is established based on:

- esophageal symptoms
- dense eosinophilic oesophageal infiltration
- exclusions of other conditions leading to oesophageal eosinophilia



Eosinophilic Esophagitis (click here to enlarge the image).

Treatment

Treatment modalities for EoE include the 3Ds: drugs, diet, and dilation (Allergy, 2012).

1. Topical corticosteroids lead to a rapid improvement of active EoE clinically and histologically.

2. Especially in children, elimination diets can have similar efficacy as topical corticosteroids.

3. Esophageal dilation of EoE-induced esophageal strictures can also be effective in improving symptoms, but this therapy has no effect on the underlying inflammation.

In any case, neither the diagnostic nor the long-term therapeutic strategies are as yet defined.

References:

Eosinophilic oesophagitis: latest intelligence. Schoepfer AM, Simon D, Straumann A. Clin Exp Allergy. 2011 Mar 24. doi: 10.1111/j.1365-2222.2011.03739.x.

Comments from Twitter:

@RyanMadanickMD: Disagree, NOT "main" cause in adults, though certainly EoE is increasing in both prevalence and incidence -- MT @DrVes: Eos esophagitis as the main cause of dysphagia in adults goo.gl/wKxI1

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