|
Eosinophilic Esophagitis
Allergic Esophagitis
General Considerations
- Can occur at any age but has more often been reported in children
- More common in males
- Prevalence appears to be increasing
- Often occurs in association with asthma, eczema, chronic rhinitis and family history of atopy
- Believed secondary to contact sensitivity with mucosa
- Cow's milk protein is most common but soy, egg and wheat have also been implicated
- Biopsy shows marked (>15-20 eosinophils) eosinophilic infiltration of epithelium
Clinical Findings
- Intermittent dysphagia
- Heartburn
- Food impaction (common presentation in adults especially)
- Chest pain
- Older children may demonstrate vomiting, regurgitation epigastric and chest pain
Imaging Findings
- Barium swallow is usually the initial study in workup but the findings are not pathognomonic
- Featureless small-caliber esophagus
- Entire esophagus may be narrowed and difficult to appreciate radiologically
- Focal esophageal narrowing
- Ringed esophagus
- The narrowing tends to occur more proximal than with GERD
- Corrugated esophagus with multiple concentric mucosal rings
- Small caliber of esophageal lumen
- Requires biopsy for diagnosis
Differential Diagnosis
- Gastro-esophageal reflux (GERD)
- Schatzki's ring
- Corrosive esophagitis
- Infectious esophagitis
- Radiation-induced
Treatment
- Fails to respond to usual treatment for GERD
- Controversial
- Removal of food allergen
- Oral corticosteroids treat symptoms but they tend to recurs when treatment is stopped
Complications
- Stricture formation
- Can be part of eosinophilic gastroenteritis
Prognosis
- Long-term outcome studies are not available yet
Eosinophilic Esophagitis. There is persistent narrowing of the distal esophagus with smooth
borders and no overhanging edge. The finding is not specific for eosinophilic esophagitis,
which requires biopsy for diagnosis, but should be consider in a younger patient with
a history of allergies or asthma.
For these same photos without the arrows, click here
For more information, click on the link if you see this icon
Eosinophilic esophagitis, GI Motility online (2006), Samuel Nurko and Glenn T. Furuta
Esophagitis, eMedicine: Jessica Wen, Andrew S Chu, Maria Rebello Mascarenhas
|
|
|