Eosinophilic Esophagitis
Eosinophilic Esophagitis
EoE has been described in patients of all ages, though it is most common in children and adults before their 5th decade. The condition is also more common in men and whites, though the reasons for this are not known. Symptoms of EoE vary by patient age. In children, symptoms can be somewhat nonspecific and include feeding intolerance or food refusal, poor growth, abdominal pain, nausea, vomiting, or regurgitation. In adolescents and adults, dysphagia is the hallmark of EoE. The frequency of dysphagia varies by study design and population, but rates can range from 25 to 100%. In cases wherein patients have esophageal food impaction and present to an emergency room for bolus clearance, EoE is now the leading cause, accounting for approximately 50% of such cases.
The symptom of heartburn can be seen in both children and adults with EoE. Depending on the series, 10–100% of EoE patients have noted heartburn or chest discomfort. EoE may also be the cause in a small proportion of patients thought to have gastroesophageal reflux disease (GERD) with symptoms refractory to proton pump inhibitor (PPI) therapy. This proportion has been reported to range from 1 to 8%. A recent analysis suggested that obtaining esophageal biopsies in PPI-refractory GERD was only cost-effective if the prevalence of EoE was at least 8%.
Concomitant atopic diseases, such as asthma, atopic dermatitis, allergic rhinitis/sinusitis, and food allergies, are also seen frequently in patients with EoE. This issue has been studied in detail in children, in whom 50–80% have coexisting atopy. There are fewer data in adults, but the results of available studies are similar. There are some patients with EoE who do not have atopic disease, and the role of referral to an allergist remains controversial, with referral rates largely dependent on local expertise and practice patterns. Of note, no symptom or associated atopic disorder is specific for the diagnosis of EoE.
Clinical Presentation of Eosinophilic Esophagitis
EoE has been described in patients of all ages, though it is most common in children and adults before their 5th decade. The condition is also more common in men and whites, though the reasons for this are not known. Symptoms of EoE vary by patient age. In children, symptoms can be somewhat nonspecific and include feeding intolerance or food refusal, poor growth, abdominal pain, nausea, vomiting, or regurgitation. In adolescents and adults, dysphagia is the hallmark of EoE. The frequency of dysphagia varies by study design and population, but rates can range from 25 to 100%. In cases wherein patients have esophageal food impaction and present to an emergency room for bolus clearance, EoE is now the leading cause, accounting for approximately 50% of such cases.
The symptom of heartburn can be seen in both children and adults with EoE. Depending on the series, 10–100% of EoE patients have noted heartburn or chest discomfort. EoE may also be the cause in a small proportion of patients thought to have gastroesophageal reflux disease (GERD) with symptoms refractory to proton pump inhibitor (PPI) therapy. This proportion has been reported to range from 1 to 8%. A recent analysis suggested that obtaining esophageal biopsies in PPI-refractory GERD was only cost-effective if the prevalence of EoE was at least 8%.
Concomitant atopic diseases, such as asthma, atopic dermatitis, allergic rhinitis/sinusitis, and food allergies, are also seen frequently in patients with EoE. This issue has been studied in detail in children, in whom 50–80% have coexisting atopy. There are fewer data in adults, but the results of available studies are similar. There are some patients with EoE who do not have atopic disease, and the role of referral to an allergist remains controversial, with referral rates largely dependent on local expertise and practice patterns. Of note, no symptom or associated atopic disorder is specific for the diagnosis of EoE.
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