Eosinophilic esophagitis
Friday 03 July 2009, Branislav Kunčak, M. D.
Although the pathogenesis of eosinophilic esophagitis is not completely understood, it is thought to be an allergic inflammatory disease (also referred as "the asthma of the esophagus"). This well recognized disease in children has been increasingly reported lately also in adults. Atopy often accompanies eosinophilic esophagitis. Eosinophilic esophagitis most commonly presents with dysphagia, food impaction and heartburn, which does not respond well to PPI. Endoscopic abnormalities linked to this disease are often very subtle and diverse.
Endoscopic features of eosonophilic esophagitis:
- small caliber esophagus
- mucosal rings ("coiled spring" appearance of the esophagus, "feline esophagus")
- vertical furrows
- exudates
- fragile mucosa ("crêpe paper mucosa") with high frequency of esophageal tears following diagnostic endoscopy
However, esophagus may appear also completily normal.
Histology play a crucial role in establishing a diagnosis. Characteristic histological finding is eosinophilic infiltrate of the epithelium (>20 eosinophils per HPF). Eosinophilic infiltrate can be observed also in reflux esophagitis. Although it is usually limited to the distal esophagus and the density of the infiltrate is lower.
Topical steroids has proven efficacy in treatment of eosinophilic esophagitis in adults. Cautious esophageal dilation appear to be essential for the successful relief of dysphagia. But more controlled studies needed to provide definite recommendations for the treatment.
»Yan BM, Shaffer EA. Nat Clin Pract Gastroenterol Hepatol. 2006;3(5):285-289.
Bigger image, Endoscopy
Fig. 1
Small caliber esophagus with multiple rings (coiled spring appearance of the esophagus).
Bigger image, Endoscopy
Fig. 2
Small caliber esophagus (comparison with the open jaws of the biopsy forceps- app. 7mm).
