From the Guidelines
The singular form of eosinophilia esophagitis is indeed eosinophilic esophagitis (EE). This condition is characterized by the infiltration of eosinophils in the esophageal mucosa, leading to inflammation and dysfunction of the esophagus, as defined in a systematic review and consensus recommendations for diagnosis and treatment 1. The term "eosinophilic" refers to the presence of eosinophils, a type of white blood cell involved in allergic responses, while "esophagitis" indicates inflammation of the esophagus. Some key points about eosinophilic esophagitis include:
- It is a chronic immune-mediated condition
- It typically presents with symptoms such as difficulty swallowing (dysphagia), food impaction, chest pain, and heartburn
- It is often associated with allergic conditions and may be triggered by specific food allergens or environmental factors
- The diagnosis requires endoscopic evaluation with biopsies showing elevated eosinophil counts in the esophageal tissue, as noted in the study published in Gastroenterology 1. Treatment approaches for eosinophilic esophagitis may include:
- Dietary modifications to eliminate potential allergens
- Proton pump inhibitors
- Topical corticosteroids (such as fluticasone or budesonide)
- In severe cases, endoscopic dilation to address strictures that may develop due to chronic inflammation.
From the Research
Definition and Diagnosis
- Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus, diagnosed in the setting of symptoms of esophageal dysfunction and an eosinophilic predominant infiltrate in the esophagus 2.
- The diagnosis can be established when both symptoms of esophageal dysfunction (usually dysphagia) and an eosinophilic infiltration of at least 15 eosinophils per high-power field (HPF) are present 3, 4.
Treatment Options
- The mainstay of management includes the 3 d's (diet, drugs, dilation): dietary modifications to eliminate trigger food groups; medications including proton pump inhibitors, swallowed topical glucocorticoids, and dupilumab; and esophageal dilation to manage strictures 4, 2.
- Various elimination diets have been found to be effective, including 1-food, 2-food, 4-food, and 6-food elimination diets 4.
- Proton-pump inhibitors (PPIs) are the most administered first-line treatment for EoE, but only around half of EoE patients respond histologically to a double dosage of PPI 5.