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:
Endoscopic signs of the eosinophilic esophagitis. (A) longitudinal furrows, (B) Edema, (C) Exudate, (D) Pseudo rings, (F) Stenosis, (G) Fragility of the mucosa. | Multidisciplinary Group of Eosinophilic Esophagitis of the General University Hospital of Ciudad Real
Images of endoscopic features of EoE. a White exudates (Courtesy of Dr. Hien Huynh.) b. Linear furrows (Courtesy of Dr. Hien Huyn) c. Linear tear plus concentric rings, d. Edema, furrows and exudates (c&d courtesy of Dr. Adrian Jones)
Findings:
Linear furrowing: Vertical oesophageal lines/ridges in the oesophageal wall
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:
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
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
