Skip to main content

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus that commonly presents with dysphagia in the pediatric population and is characterized histologically by eosinophil-rich inflammation. Traditionally, these patients have been managed by providers in allergy/immunology, gastroenterology, and otolaryngology. With increased knowledge regarding disease presentation and progression, improved assessment and treatment strategies have been developed. When feeding dysfunction and airway conditions present, a multidisciplinary approach to management with speech-language pathology and otolaryngology has been employed. This chapter reviews the clinicopathology of eosinophilic esophagitis as well as its evolving multidisciplinary treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Attwood SEA, Smyrk TC, Demeester TR, Jones JB. Esophageal eosinophilia with dysphagia – a distinct clinicopathologic syndrome. Dig Dis Sci. 1993;38:109–16.

    Article  CAS  PubMed  Google Scholar 

  2. Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351:940–1.

    Article  CAS  PubMed  Google Scholar 

  3. DeBrosse CW, Collins MH, Buckmeier Butz BK, et al. Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982–1999. J Allergy Clin Immunol. 2010;126:112–9.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Dantuluri S, Ramani P, Basude D, et al. Eosinophilic oesophagitis: are we missing it? J Pediatr Gastroenterol Nutr. 2009;48:E143.

    Google Scholar 

  5. Cherian S, Smith NM, Forbes DA. Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child. 2006;91(12):1000–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Robson J, O’Gorman M, McClain A, Mutyala K, Davis C, Barbagelata C, et al. Incidence and prevalence of pediatric eosinophilic esophagitis in Utah based on a 5-year population-based study. Clin Gastroenterol Hepatol. 2019;17(1):107–14.e1.

    Article  PubMed  Google Scholar 

  7. Noti M, Wojno EDT, Kim BS, Siracusa MC, Giacomin PR, Nair MG, et al. Thymic stromal lymphopoietin–elicited basophil responses promote eosinophilic esophagitis. Nat Med. 2013;19:1005–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Jyonouchi S, Smith CL, Saretta F, Abraham V, Ruymann KR, Modayur-Chandramouleeswaran P, et al. Invariant natural killer T cells in children with eosinophilic esophagitis. Clin Exp Allergy. 2014;44:58–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Straumann A, Bauer M, Fischer B, Blaser K, Simon H-U. Idiopathic eosinophilic esophagitis is associated with a TH2-type allergic inflammatory response. J Allergy Clin Immunol. 2001;108:954–61.

    Article  CAS  PubMed  Google Scholar 

  10. Mishra A, Hogan SP, Brandt EB, Rothenberg ME. IL-5 promotes eosinophil trafficking to the esophagus. J Immunol. 2002;168:2464–9.

    Article  CAS  PubMed  Google Scholar 

  11. Travers J, Rothenberg ME. Eosinophils in mucosal immune responses. Mucosal Immunol. 2015;8:464–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Mueller S, Aigner T, Neureiter D, Stolte M. Eosinophil infiltration and degranulation in oesophageal mucosa from adult patients with eosinophilic oesophagitis: a retrospective and comparative study on pathological biopsy. J Clin Pathol. 2006;59:1175–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Saffari H, Hoffman LH, Peterson K, Fang JC, Leiferman KM, et al. Electron microscopy elucidates eosinophil degranulation patterns in patients with eosinophilic esophagitis. J Allergy Clin Immunol. 2014;133:1728–34.

    Article  CAS  PubMed  Google Scholar 

  14. Aceves SS, Newbury RO, Dohil R, Bastian JF, Broide DH. Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol. 2007;119:206–12.

    Article  CAS  PubMed  Google Scholar 

  15. Alexander ES, Martin LJ, Collins MH, Kottyan LC, Sucharew H, He H, et al. Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis. J Allergy Clin Immunol. 2014;134:1084–92.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Allen-Brady K, Firszt R, Fang JC, Wong J, Smith KR, Peterson KA. Population-based familial aggregation of eosinophilic esophagitis suggests a genetic contribution. J Allergy Clin Immunol. 2017;140(4):1138–43.

    Article  PubMed  Google Scholar 

  17. Blanchard C, Wang N, Stringer KF, Mishra A, Fulkerson PC, Abonia JP, et al. Eotaxin-3 and a uniquely conserved gene expression profile in eosinophilic esophagitis. J Clin Invest. 2006;116:536–47.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Blanchard C, Stucke EM, Burwinkel K, Caldwell JM, Collins MH, Ahrens A, et al. Coordinate interaction between IL-13 and epithelial differentiation cluster genes in eosinophilic esophagitis. J Immunol. 2010;184:4033–41.

    Article  CAS  PubMed  Google Scholar 

  19. Kottyan LC, Davis BP, Sherrill JD, Liu K, Rochman M, Kaufman K, et al. Genome-wide association analysis of eosinophilic esophagitis provides insight into the tissue specificity of this allergic disease. Nat Genet. 2014;46:895–900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Rothenberg ME, Spergel JM, Sherrill JD, Annaiah K, Martin LJ, Cianferoni A, et al. Common variants at 5q22 associate with pediatric eosinophilic esophagitis. Nat Genet. 2010;42(4):289–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Sleiman PM, Wang ML, Cianferoni A, Aceves S, Gonsalves N, Nadeau K, et al. GWAS identifies four novel eosinophilic esophagitis loci. Nat Commun. 2014;5:5593.

    Article  PubMed  Google Scholar 

  22. Kottyan LC, Maddox A, Braxton JR, et al. Genetic variants at the 16p13 locus confer risk for eosinophilic esophagitis. Genes Immun. 2019;20(4):281–92.

    Article  CAS  PubMed  Google Scholar 

  23. Abonia JP, Wen T, Stucke EM, Grotjan T, Griffith MS, Kemme KA, et al. High prevalence of eosinophilic esophagitis in patients with inherited connective tissue disorders. J Allergy Clin Immunol. 2013;132:378–86.

    Article  PubMed  Google Scholar 

  24. Dellon ES, Jensen ET, Martin CF, Shaheen NJ, Kappelman MD. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol. 2014;12:589–96.e1.

    Article  PubMed  Google Scholar 

  25. Sun RW, Bonilla-Velez J, Pesek RD, Johnson AB, Cleves MA, Richter GT. Eosinophilic esophagitis in children under the age of 5 years: clinical characteristics. Laryngoscope. 2018;128(4):798–805.

    Article  CAS  PubMed  Google Scholar 

  26. Spergel JM, Brown-Whitehorn TF, Beausoleil JL, Franciosi J, Shuker M, Verma R, et al. 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr. 2009;48:30–6.

    Article  PubMed  Google Scholar 

  27. Mukkada VA, Haas A, Maune NC, et al. Feeding dysfunction in children with eosinophilic gastrointestinal diseases. Pediatrics. 2010;126:e672–e77.

    Article  PubMed  Google Scholar 

  28. Sugnanam KKN, Collins JT, Smith PK, Connor F, Lewindon P, Cleghorn G, et al. Dichotomy of food and inhalant allergen sensitization in eosinophilic esophagitis. Allergy. 2007;62:1257–60.18.

    Article  CAS  PubMed  Google Scholar 

  29. Assa’ad AH, Putnam PE, Collins MH, Akers RM, Jameson SC, Kirby CL, et al. Pediatric patients with eosinophilic esophagitis: an 8-year follow-up. J Allergy Clin Immunol. 2007;119:731–8.

    Article  PubMed  Google Scholar 

  30. Ruffner MA, Spergel JM. Eosinophilic esophagitis in children. Curr Allergy Asthma Rep. 2017;17(8):54.

    Article  PubMed  Google Scholar 

  31. Liacouras CA, Spergel JM, Ruchelli E, et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol. 2005;3(12):1198.

    Article  PubMed  Google Scholar 

  32. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology. 2018;155(4):1022.

    Article  PubMed  Google Scholar 

  33. Davis BP, Rothernberg ME. Mechanisms of disease in eosinophilic esophagitis. Annu Rev Pathol. 2016;11:365–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Sherrill JD, Rothenberg ME. Genetic dissection of eosinophilic esophagitis provides insight into disease pathogenesis and treatment strategies. J Allergy Clin Immunol. 2011;128(1):23–32.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Papadopoulou A, Koletzko S, Heuschkel R, et al. Management guidelines of eosinophilic esophagitis in childhood. JPGN. 2014;58:107–18.

    CAS  PubMed  Google Scholar 

  36. Paddack A, Gibbons T, Smith C, Patil S, Richter GT. Food hypersensitivity and otolaryngologic conditions in young children. Otolaryngol Head Neck Surg. 2012;147(2):215–20.

    Article  PubMed  Google Scholar 

  37. Dauer EH, Freese DK, El-Youssef M, Thompson DM. Clinical characteristics of eosinophilic esophagitis in children. Ann Otol Rhinol Laryngol. 2005;114:827–33.

    Article  PubMed  Google Scholar 

  38. Orenstein SR, Shalaby TM, Di Lorenzo C, et al. The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol. 2000;95:1422–30.

    Article  CAS  PubMed  Google Scholar 

  39. Thompson DM, Orvidas LJ. Otorhinolaryngologic manifestations of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18(1):91–8.. ix

    Article  PubMed  Google Scholar 

  40. Dauer EH, Ponikau JU, Smyrk TC, et al. Airway manifestations of pediatric eosinophilic esophagitis: a clinical and histopathologic report of an emerging association. Ann Otol Rhinol Laryngol. 2006;115:507–17.

    Article  PubMed  Google Scholar 

  41. Hartnick C, Liu J, Cotton R, et al. Subglottic stenosis complicated by allergic esophagitis: case report. Ann Otol Rhinol Laryngol. 2002;111:57–60.

    Article  PubMed  Google Scholar 

  42. Thompson DM, Arora AS, Romero Y, et al. Eosinophilic esophagitis: its role in aerodigestive tract disorders. Otolaryngol Clin N Am. 2006;39:205–21.

    Article  Google Scholar 

  43. Hill CA, Ramakrishna J, Fracchia MS, et al. Prevalence of eosinophilic esophagitis in children with refractory Aerodigestive symptoms. JAMA Otolaryngol Head Neck Surg. 2013;139(9):903–6.

    Article  PubMed  Google Scholar 

  44. Otteson TD, Mantle BA, Casselbrant ML, Goyal A. The otolaryngologic manifestations in children with eosinophilic esophagitis. Int J Pediatr Otorhinolaryngol. 2012;76(1):116–9.

    Article  PubMed  Google Scholar 

  45. White DR, Cotton RT, Bean JA, Rutter MJ. Pediatric cricotracheal resection: surgical outcomes and risk factor analysis. Arch Otolaryngol Head Neck Surg. 2005;131(10):896–9.

    Article  PubMed  Google Scholar 

  46. Blanchard C, Stucke EM, Rodriguez-Jimenez B, Burwinkel K, et al. A striking local esophageal cytokine expression profile in eosinophilic esophagitis. J Allergy Clin Immunol. 2011;127(1):208–17.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Chandramouleeswaran PM, Shen D, Lee AJ, Benitez A, et al. Preferential secretion of thymic stromal lymphopoietin (TSLP) by terminally differentiated esophageal epithelial cells: relevance to eosinophilic esophagitis (EoE). PLoS One. 2016;11:e0150968.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  48. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, et al. Eosinophilic Esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109:1503–12.

    Article  CAS  PubMed  Google Scholar 

  49. Rodriguez-Sanchez J, Gomez-Torrijos E, Lopez Viedma B, de la Santa Belda E, et al. Efficacy of IgE-targeted vs. empiric six food elimination diets for adult eosinophilic oesophagitis. Allergy. 2014;69:936–42.

    Article  CAS  PubMed  Google Scholar 

  50. Gonsalves N, Yang GY, Doerfler B, Ritz S, et al. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology. 2012;142:1451–9.

    Article  PubMed  Google Scholar 

  51. Spergel JM, Brown-Whitehorn TF, Cianferoni A, Shuker M, et al. Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. J Allergy Clin Immunol. 2012;130:461–7.

    Article  PubMed  Google Scholar 

  52. Eckmann JD, Ravi K, Katzka DA, Davis DR, et al. Efficacy of atopy patch testing in directed dietary therapy of eosinophilic esophagitis: a pilot study. Dig Dis Sci. 2018;63:694–702.

    Article  PubMed  Google Scholar 

  53. Arias A, Gonzalez-Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014;146:1639–48.

    Article  PubMed  Google Scholar 

  54. Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA. Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol. 2003;98:777–82.

    Article  CAS  PubMed  Google Scholar 

  55. Henderson CJ, Abonia JP, King EC, Putnam PE, et al. Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis. J Allergy Clin Immunol. 2012;129:1570–8.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Kagalwalla AF, Amsden K, Shah A, et al. Cow’s milk elimination: a novel dietary approach to treat eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2012;55:711–6.

    Article  CAS  PubMed  Google Scholar 

  57. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4:1097–102.

    Article  PubMed  Google Scholar 

  58. Kagalwalla A, Amsden K, Makhija MM, et al. A multicenter study assessing the clinical, endoscopic and histologic response to four food elimination diet for the treatment of eosinophilic esophagitis. Gastroenterology. 2015;148(Suppl 1):S-30.

    Article  Google Scholar 

  59. Molina-Infante J, Arias A, Alcedo J, Garcia-Romero R, et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2-4-6 study. J Allergy Clin Immunol. 2018;141:1365–72.

    Article  PubMed  Google Scholar 

  60. Fogg MI, Ruchelli E, Spergel JM. Pollen and eosinophilic esophagitis. J Allergy Clin Immunol. 2003;112:796–7.

    Article  PubMed  Google Scholar 

  61. Moawad FJ, Veerappan GR, Lake JM, et al. Correlation between eosinophilic oesophagitis and aeroallergens. Aliment Pharmacol Ther. 2010;31:509–15.

    Article  CAS  PubMed  Google Scholar 

  62. van Rhijn BD, van Ree R, Verseeg SA, et al. Birch pollen sensitization with cross-reactivity to food allergens predominates in adults with eosinophilic esophagitis. Allergy. 2013;68:1475–81.

    Article  PubMed  CAS  Google Scholar 

  63. Reed CC, Iglesia EGA, Commins SP, Dellon ES. Seasonal exacerbation of eosinophilic esophagitis histologic activity in adults and children implicates role of aeroallergens. Ann Allergy Asthma Immunol. 2019;122(3):296–301.

    Article  PubMed  Google Scholar 

  64. Ram G, Lee J, Ott M, Brown-Whitehorn TF, Cianferoni A, et al. Seasonal exacerbation of esophageal eosinophilia in children with eosinophilic esophagitis and allergic rhinitis. Ann Allergy Asthma Immunol. 2015;115:224–8.

    Article  PubMed  Google Scholar 

  65. Philpott HL, Nandurkar S, Thien F, Bloom S, et al. Seasonal recurrence of food bolus obstruction in eosinophilic esophagitis. Intern Med J. 2015;45:939–43.

    Article  CAS  PubMed  Google Scholar 

  66. Lucendo AJ, Arias A, Redondo-Gonzalez O, Gonzalez-Cervera J. Seasonal distribution of initial diagnosis and clinical recrudescence of eosinophilic esophagitis: a systematic review and meta-analysis. Allergy. 2015;70:1640–50.

    Article  CAS  PubMed  Google Scholar 

  67. Ramirez RM, Jacobs RL. Eosinophilic esophagitis treated with immunotherapy to dust mites. J Allergy Clin Immunol. 2013;132:503–4.

    Article  PubMed  Google Scholar 

  68. Menard-Katcher C, Henry M, Furuta GT, Atkins D, Creskoff Maune N, Haas AM. Significance of feeding dysfunction in eosinophilic esophagitis. World J Gastroenterol. 2014;20(31):11019–22.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Arvedson JC, Brodsky L. Pediatric swallowing and feeding: assessment and management. 2nd ed. Albany: Singular Publishing Group; 2002.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ravi Sun .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sun, R., Pesek, R., Kawatu, D., O’Neill, A., Richter, G.T. (2020). Eosinophilic Esophagitis. In: McMurray, J., Hoffman, M., Braden, M. (eds) Multidisciplinary Management of Pediatric Voice and Swallowing Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-26191-7_37

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-26191-7_37

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-26190-0

  • Online ISBN: 978-3-030-26191-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics