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Internal Medicine

Eosinophilic esophagitis (EoE)

Eosinophilic oesophagitis (EoE) aka allergic oesophagitis, is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms.


Clinical features

  • Dysphagia
  • Food impaction
  • Regurgitation/vomiting
  • Decreased appetite

Diagnosis

Endoscopy:

  • Findings:
    • Linear furrowing: Vertical oesophageal lines/ridges in the oesophageal wall
    • Trachealized/corrugated/ringed oesophagus: Multiple concentric fine/web-like/thickened rings
    • White speckled exudates: Patches of whitish papules of 1-2 mm diameter (resembles oesophageal candidiasis)
    • Schatzki ring: Narrow ring of tissue located just above the junction of the oesophagus and stomach
    • Small-calibre esophagus:
      • Narrowed oesophagus, with fixed internal diameter
      • Featureless, unchanging column
      • Poor expansion on air insufflation
      • Proximal and/or distal stenosis
    • Linear superficial mucosal tears: Mucosal abrasions/shearing that occur upon minimal contact (e.g., after simple passage of a routine endoscope)

Barium swallow:

eosinophilic_esophagitis-barium_swallow
The barium swallow of the oesophagus on the left side shows multiple rings associated with eosinophilic oesophagitis. | Runder – Flickr, CC BY 2.0, https://commons.wikimedia.org/w/index.php?curid=1139695

Management

13223_2018_287_fig2_html
Simplified algorithm for the diagnosis and management of EoE [39]. EoE eosinophilic esophagitis, PPI proton pump inhibitor, GERD gastrointestinal reflux disease, HPF high power field, PPI-REE proton pump inhibitor responsive esophageal eosinophilia | Carr, S., Chan, E. S., & Watson, W. (2018). Eosinophilic esophagitis. Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology, 14(Suppl 2), 58. https://doi.org/10.1186/s13223-018-0287-0

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