Feature Review:

Eosinophilic Esophagitis (EE): An Update

Vincent St Aubyn Crump ? July 2008

Introduction

Eosinophilic esophagitis is a chronic allergic inflammatory condition of the esophagus (the muscular tube that propels food from the mouth to the stomach), that is associated with increased numbers of eosinophils (a type of white blood cells that promotes inflammation, and their numbers are usually elevated in blood above the normal range with allergic reactions and parasitic infections as with worms). in the oesophagus. It affects both adults and children, but males more than female.

EE is characterized by symptoms including but not restricted to solid-food dysphagia (difficulty swallowing) and food impaction in adults, and feeding intolerance and GERD symptoms in children. The majority of these patients are atopic (has asthma, eczema or hay fever), with positive skin prick tests to several allergens including foods, which may contribute to their symptoms. In the past, patients with EE were incorrectly diagnosed as GERD, and treated with acid blockers (proton pump inhibitors). It has been found that patients with EE have normal pH in their GI tract, hence the poor response to acid blockers.

Epidemiology

EE appears to be a new disease with a rapidly increasing incidence, possibly due to both increased recognition and a genuine increase in the number of cases. The first case series have been reported in the 1970s (1). Since then there have been more than 200 publications. Increasing recognition is unlikely to fully account for the increasing number of recognized cases because gastrointestinal barium studies have been practiced for decades, and therefore the characteristic ridged pattern seen in the esophagus in patients with EE would have been described earlier

EE shows a worldwide distribution. It has been reported in Australia, Belgium, Chile, Denmark, England, France, Germany, Greece, Italy, Japan, Mexico, The Netherlands, New Zealand, Spain, Sweden, Switzerland and the United States. So far there have been no reports from Africa.

It is distinctly more common in males, and affects patients of all ages. It was previously thought to be more common in children, but this is now believed to be due to previous underdiagnosis in adults. It peaks in young adults 20-40 years.

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