Clinical Features, Diagnosis, Treatment And Prognosis Of Eoe
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Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus represented by intense eosinophilic infiltration of the esophageal epithelium that is not responsive to proton-pump inhibitor (PPI) therapy. The increasing diagnosis of EoE, both in children and adults, over the last decade is potentially due to both recognition and increase in incidence. This has resulted in a dramatic increase in the medical literature surrounding this condition. This article will provide a practical overview of epidemiology, clinical features, diagnosis, treatment and prognosis of EoE.
EoE is a clinico-pathologic diagnosis characterized by symptoms of esophageal dysfunction and eosinophilic inflammation (>15 eosinophils per high power field) of the esophagus after other causes of esophageal eosinophilia have been excluded.
Several population-based studies have shown that the incidence and prevalence of EoE is on the rise, especially in western countries. It, however, is unclear as to whether the new cases of EoE represent a true increase in prevalence or rather increased recognition of the disease, or both.
Regardless, EoE is now one of the most common causes of food impaction in patients presenting to the emergency department. Prevalence of EoE is estimated at 0.5 -1 in 1000 in western countries, making it as common as inflammatory bowel disease. EoE affects patient of all age groups, but has bimodal peak incidences between the ages of 5 to 10 years and in the fourth decade of life. Males are 3 to 4 times more commonly affected than females. EoE is also more common in Caucasians and has a strong association with concomitant atopy such as asthma, eczema, rhinitis and food allergies.
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...s in the esophageal mucosa, also referred to as linear furrows; white specks of the esophageal mucosa (WSEM) which are highly specific for this entity and represent small clusters of eosinophilic abscesses on histopathological examination (care should be taken not to confuse these with candidal infection); circular rings of the esophageal mucosa also termed trachealization of the esophagus which are less commonly seen in the young child, but are more prevalent in older children and adults and represent chronic remodeling changes in esophagus.
Careful examination of esophageal mucosal biopsies is necessary for the diagnosis of EoE. To differentiate EoE from gastroesophageal reflux related esophagitis, which would generally be limited to the distal esophagus, it is recommended to obtain multiple biopsies from different levels of the esophagus.