Esophageal Eosinophilia ( Ee ) Essay

Esophageal Eosinophilia ( Ee ) Essay

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The first cases of what was most likely Esophageal eosinophilia (EE) were reported in the late 1960’s and early 1970’s. EE was first thought of as a manifestation of GERD. Around twenty years ago it was realized however, that it did not respond to acid suppression but did respond to an elemental-formula diet. EE is defined by the presence of eosinophils in the epithelium of the esophagus. Eosinophilic esophagitis (EoE) is defined as “chronic, immune-mediated or antigen mediated esophageal disease characterized by symptoms related to esophageal dysfuntion and eosinophil-predominant inflammation.” EoE can have associated complications such as esophageal stricture, perforation, malnutrition, and food impations. Recognition of EoE has been increasing in both children and adults. It is thought that this is due to both an increase in incidence and a growing awareness of the condition. It is more common in white males.3 Onset time is typically from school age to midlife.2 Estimates put the prevalence at 4-6 per 10,000. It is important to note that there is a poorly understood overlap between EoE and GERD.
The main antigens involved in EoE appear to be food based. Clinically speaking, EoE has several components. First, there are feeding problems, vomiting, and abdominal pain in young children. In adolescents and adults there is dysphagia and food impaction. Second, the esophageal mucosa has eosinophils present, at least 15 per high-powered field. Other causes of these finding must be ruled out. Of particular importance is GERD which is difficult to rule out.2 This is especially true since recognition of proton-pump inhibitor (PPI)-responsive esophageal eosinophilia (PPI-REE). The interconnectedness of GERD, EoE, and PPI-REE are not...


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...doscopy with biopsies should be done to assess response from either withdrawing food or reintroducing food.
16. Allergists should be consulted to treat any allergies and to help guide elemental and elimination diets.
17. Conservatively approached esophageal dilation may be used if strictures persist despite dietary or medical intervention.
18. Patients should be informed of the risks of dilation.
19. Patients should be reminded that EoE is a chronic condition and symptoms are likely to return if treatment is discontinued.
20. Maintenance therapy should prevent complications, minimize symptoms and adverse effects of treatments, and preserve quality of life.
21. Maintenance topical steroids and/or dietary treatment is appropriate. This is especially true for those with food impaction or dysphagia, high grade stricture, and rapid relapse following initial therapy.

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