Eosinophilic esophagitis

Lore & Background

Eosinophilic esophagitis was first described in children but is now recognized in all age groups, with symptoms varying by age. In young children, feeding difficulties and poor weight gain are common; school-aged children and adolescents often experience difficulty swallowing, food impaction, and choking with coarse foods. Adults predominantly report difficulty swallowing, intractable heartburn, and food avoidance, and they tend to have more episodes of esophageal food impaction due to long-standing inflammation and scarring. The condition is more common in males and is often associated with other autoimmune and allergic diseases such as asthma, celiac disease, and mast cell disorders.

Reader's Guide

Eosinophilic esophagitis is significant as a relatively recently recognized condition that bridges allergy and gastroenterology. Its pathophysiology involves antigen exposure triggering a hyperactive immune response, with eosinophils migrating to the esophagus and causing tissue damage. Diagnosis requires endoscopic biopsy showing at least 15 eosinophils per high-power field, after excluding other causes such as GERD, achalasia, and Crohn's disease.

Treatment includes dietary management, such as the six-food elimination diet, medications to suppress the immune response, and endoscopic dilation for severe strictures. Its recognition has grown rapidly, though diagnosis remains challenging due to nonspecific symptoms and histopathologic findings. EoE highlights the complex interplay between environmental triggers, genetic susceptibility, and immune dysregulation in esophageal disease.