Digestive Diseases and Sciences

, Volume 48, Issue 1, pp 22–29

Eosinophilic Esophagitis: Strictures, Impactions, Dysphagia

  • Seema Khan
  • Susan R. Orenstein
  • Carlo Di Lorenzo
  • Samuel A. Kocoshis
  • Philip E. Putnam
  • Luther Sigurdsson
  • Theresa M. Shalaby
Article

DOI: 10.1023/A:1021769928180

Cite this article as:
Khan, S., Orenstein, S.R., Di Lorenzo, C. et al. Dig Dis Sci (2003) 48: 22. doi:10.1023/A:1021769928180
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Abstract

Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with >5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with >20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5–20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if <20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with >20 eos/hpf.

esophagitis eosinophilia gastroesophageal reflux food allergies 

Copyright information

© Plenum Publishing Corporation 2003

Authors and Affiliations

  • Seema Khan
    • 1
  • Susan R. Orenstein
    • 1
  • Carlo Di Lorenzo
    • 1
  • Samuel A. Kocoshis
    • 1
  • Philip E. Putnam
    • 1
  • Luther Sigurdsson
    • 1
  • Theresa M. Shalaby
    • 1
  1. 1.Division of Pediatric GastroenterologyUniversity of Pittsburgh School of Medicine, Children's Hospital of PittsburghPennsylvaniaUSA

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