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Current Approach to the Management of Eosinophilic Esophagitis in Adults

  • Motility (T Lembo, Section Editor)
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Opinion statement

Eosinophilic esophagitis (EoE) is an increasingly diagnosed, immune-mediated disease characterized by inflammation of the esophagus in both children and adult, causing significant morbidity. Adults typically present with dysphagia and a history of food impaction. Diagnosis should be considered in patients with histological evidence of eosinophilia (≥15 eosinophils per high-power field) on esophageal biopsy. More recently, it has been observed that a significant percentage of patients with esophageal eosinophilia respond both clinically and histologically to PPI therapy. This disorder has been named PPI-responsive esophageal eosinophilia (PPI-REE). Recent studies suggest that patients with PPI-REE have similar clinical and endoscopic features of patients with EoE. Specifically, both PPI-REE and EoE patients have a strong disposition to allergy compared to patients without eosinophilia. As such, PPI-REE may represent a subset or variant of EoE. Effective treatment of EoE requires a multidisciplinary approach with gastroenterologists, pathologists, allergists, and nutritionists. Treatments include elimination and elemental diets, topical glucocorticoids (fluticasone and budesonide), and endoscopic dilation.

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  1. Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Alison H. Goldin MD & Walter W. Chan MD MPH

  2. Harvard Medical School, Boston, MA, USA

    Alison H. Goldin MD & Walter W. Chan MD MPH

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Goldin, A.H., Chan, W.W. Current Approach to the Management of Eosinophilic Esophagitis in Adults. Curr Treat Options Gastro 13, 441–451 (2015). https://doi.org/10.1007/s11938-015-0069-4

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