GASTROENTEROLOGY ARTICLE OF THE WEEK
September 9, 2004
Arora AS, Yamazaki K. Eosinophilic esophagitis: Asthma of the esophagus? Clin Gastroenterol Hepatol 2004;2:523-30
1. Clinical features of eosinophilic esophagitis (EE) include
a. female predominance
b. atopic predisposition
c. over 50% of adults have peripheral eosinophilia
d. dysphagia and food bolus impaction in adults is a common presenting
symptom/sign
e. GERD is more prevalent in adults with EE
2. Endoscopic findings typical of EE include
a. erosive changes only in the distal esophagus similar to GERD
b. vertical lines in the esophageal mucosa
c. rings in the esophagus
d. mass lesion
e. findings almost always limited to the distal esophagus
f. whitish nodules or plaques, if present, usually represent Candida and not EE
True or False
3. Patients with EE are more likely to perforate after esophageal dilation.
4. Microscopic evidence of >20 eosinophils per HPF suggests EE.
5. EE affects the esophagus alone, it is rare to find gastric or intestinal involvement.
6. EE affects the esophagus in a patchy distribution, multiple biopsies are needed.
7. Treatment
a. requires systemic steroids, topical steroids are not useful
b. response to therapy may be sustained even after treatment is discontinued
c. swallowing inhaled steroids (fluticasone) may be an effective therapy with less
systemic side effects, a 6-wk course is recommended
d. Montelukast may help symptoms, but does not eradicate eosinophils and
requires continuous therapy.