Recent Advances in the Treatment of Eosinophilic Esophagitis

Shauna Schroeder; Dan Atkins; Glenn T Furuta


Expert Rev Clin Immunol. 2010;6(6):929-937. 

In This Article

Clinical Symptoms & Features of Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) has a spectrum of presenting symptoms, including feeding difficulties, failure to thrive, vomiting, epigastric and chest pain, dysphagia and food impactions. Clinical experience and increasing evidence suggests that these symptoms may develop chronologically. Whether this occurs because children are able to better express themselves with age or because eosinophilic inflammation leads to changes in functional phenotypes remains unclear.[1,2] For example, young infants and toddlers often present with failure to thrive and feeding difficulties. These early feeding difficulties may be manifested as food refusal, low variety intake, poor acceptance of new foods, unstructured mealtimes, holding food in the mouth, spitting food out and prolonged feeding time.[3] Preschool and school-aged patients commonly complain of abdominal pain or vomiting, whereas dysphagia is the primary complaint among adolescents. Dysphagia is often described as difficulty swallowing food, while some patients report food sticking temporarily in the throat or chest before moving into the stomach. A carefully taken history often reveals that these patients develop compensatory mechanisms such as eating slowly, taking small bites, chewing excessively, drinking after each bite or avoiding specific foods with denser textures that are problematic such as meat or bread.[4] Food impaction is the common complaint of the adolescent and adult patient populations. The food impactions can result from fixed esophageal strictures or esophageal dysmotility.[5] A prospective study investigating the natural history of EoE in a follow-up study of 30 adult patients for up to 11.5 years showed that EoE as a primary and chronic disease was restricted to the esophagus, led to persistent dysphagia and structural esophageal alterations, but did not impact the nutritional state. No malignant potential was associated with this disease. This study described 29 out of 30 patients with EoE who almost exclusively reported acute and recurrent dysphagia with impaction of solid foods.[6]


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