Which clinical history findings are characteristic of eosinophilic esophagitis (EoE)?

Updated: Jan 03, 2020
  • Author: Nina Tatevian, MD, PhD, FCAP; Chief Editor: Nirag C Jhala, MD, MBBS  more...
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Answer

Answer

Primary eosinophilic esophagitis (EoE) affects all ethnic groups and both sexes. There is a slight male predominance, with a male-to-female ratio of 3:1. [2] It is a disease of both children and adults. [41]

Generally, the clinical symptoms of EoE are nonspecific, and the patients are in good physical condition; therefore, in some cases, the diagnosis of EoE is made a few years after onset of symptoms.

The presenting symptoms vary depending on the age of onset. [42] Children tend to present with nausea and vomiting, weight loss, anemia, and failure to thrive. [41] In neonates and infants, refusal of food is the most common presenting symptom. [21]

In a 2012 study, Sorser et al [6] reported vomiting as the most common presenting symptom in children and adolescents (61%), followed by dysphagia (39%), abdominal pain (34%), feeding disorders (14%), heartburn (14%), food impaction (7%), vague chest pain (5%), and diarrhea (5%). They further noted that vomiting and feeding disorders affected younger children, whereas heartburn and dysphagia occurred in older children.

In contrast, the characteristic symptom in adults includes dysphagia for solid foods, retrosternal pain, and food impaction. [41] Some patients also present with GERD-like symptoms that are unresponsive to medical or surgical antireflux therapy. However, a subset of patients has been recognized to have a typical clinical presentation of EoE and have had GERD diagnostically excluded, yet show a clinicopathologic response to PPIs. This condition is currently referred to as PPI-responsive EoE. [2]

Other symptoms that often prompt clinical evaluation are throat clearing, choking, gagging, and hoarseness. [41]

Patients in both adult and pediatric age groups often have a concomitant history of allergies such as food allergies, asthma, eczema, or chronic rhinitis. The laboratory workup shows mild peripheral eosinophilia in 5%-50% of children and adults. [37] Elevated total IgE levels are seen in about 70% of patients. [37]


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