Eosinophilic esophagitis: an allergist's approach

Objective: To enhance the recognition of eosinophilic esophagitis by reviewing the presentation, diagnosis, and pathogenesis and then summarizing the epidemiology and treatment options. Data Sources: MEDLINE was searched for articles using the keywords esophagitis and either allergy or eosinophil. Additional sources include searches limited to therapy, including corticosteroids and leukotrienes, and those limited to review articles, including chemokines and cytokines, from January 1990 to April 2006. All searches were limited to the English language. Study Selection: The authors selected relevant and current sources for inclusion in this review. Results: Eosinophilic esophagitis is a diagnosis made by identifying 20 to 24 eosinophils per high-power field on examination of esophageal biopsy specimens. In recent years, a marked increase in incidence worldwide may have occurred. Although the pathogenesis is still unclear, therapy involves the use of corticosteroids and appropriate dietary elimination. Conclusion: Patients with atopy, especially mates, who present with dysphagia, reflux symptoms, vomiting, abdominal pain, or failure to thrive should be considered for endoscopy to establish the diagnosis of eosinophilic esophagitis.