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2014 ; 147
(6
): 1238-54
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Advances in clinical management of eosinophilic esophagitis
#MMPMID25109885
Dellon ES
; Liacouras CA
Gastroenterology
2014[Dec]; 147
(6
): 1238-54
PMID25109885
show ga
Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated
clinicopathologic condition that has become an increasingly important cause of
upper gastrointestinal morbidity in adults and children over the past 2 decades.
It is diagnosed based on symptoms of esophageal dysfunction, the presence of at
least 15 eosinophils/high-power field in esophageal biopsy specimens, and
exclusion of competing causes of esophageal eosinophilia, including proton pump
inhibitor-responsive esophageal eosinophilia. We review what we have recently
learned about the clinical aspects of EoE, discussing the clinical, endoscopic,
and histological features of EoE in adults and children. We explain the current
diagnostic criteria and challenges to diagnosis, including the role of
gastroesophageal reflux disease and proton pump inhibitor-responsive esophageal
eosinophilia. It is also important to consider the epidemiology of EoE (with a
current incidence of 1 new case per 10,000 per year and prevalence of 0.5 to 1
case per 1000 per year) and disease progression. We review the main treatment
approaches and new treatment options; EoE can be treated with topical
corticosteroids, such as fluticasone and budesonide, or dietary strategies, such
as amino acid-based formulas, allergy test-directed elimination diets, and
nondirected empiric elimination diets. Endoscopic dilation has also become an
important tool for treatment of fibrostenotic complications of EoE. There are a
number of unresolved issues in EoE, including phenotypes, optimal treatment end
points, the role of maintenance therapy, and treatment of refractory EoE. The
care of patients with EoE and the study of the disease span many disciplines; EoE
is ideally managed by a multidisciplinary team of gastroenterologists,
allergists, pathologists, and dieticians.
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