Analysis of symptoms and endoscopic findings in 117 patients with histological diagnoses of eosinophilic esophagitis

Background and study aims: Although eosinophilic esophagitis has been increasingly diagnosed over recent years, little is known about this disease. In this study, symptoms, accompanying allergic disorders, and endoscopic findings in 117 patients with eosinophilic esophagitis were analyzed retrospectively.

Patients and methods: The physicians who had treated the 117 patients (mean age 42.2 years; 9 children, 108 adults; male patients 71.8 %) with the histological diagnosis of eosinophilic esophagitis were asked to provide data on symptoms, accompanying allergic disorders, and endoscopic findings.

Results: In 82.2 % of the patients symptoms appeared in adulthood, predominantly between the ages of 21 and 30 years. The average duration of symptoms until final diagnosis of eosinophilic esophagitis was 4.2 years (range 0 - 44 years). The most frequent symptom was dysphagia (70.1 %), followed by heartburn (47 %), chest pain (29 %), epigastric pain (29 %), and a combination of dysphagia and heartburn (29 %). Allergic disorders were seen in 48.7 % of our patients. The most frequent endoscopic findings were stipple-like exudates (25.6 %), linear fissures (25.6 %), and reddening (25.6 %), followed by rings (18.8 %) and strictures (16.2 %) of the esophagus. The esophageal mucosa was regarded as “normal” in 24.8 % of the patients.

Conclusion: Dysphagia in the second or third decade of life may suggest eosinophilic esophagitis. Symptoms of eosinophilic esophagitis may be indistinguishable from those of gastroesophageal reflux disease. The endoscopic appearance is not specific. Biopsies taken from multiple locations in the esophageal mucosa are essential for diagnosis of eosinophilic esophagitis.

References

• 1 Dobbins J W, Sheahan D G, Behar J. Eosinophilic gastroenteritis with esophageal involvement.  Gastroenterology. 1977;  72 1312-1316
• 2 Faubion W, Perrault J, Burgart L. et al . Treatment of eosinophilic esophagitis with inhaled corticosteroids.  J Pediatr Gastroenterol Nutr. 1998;  27 90-93
• 3 Fox V L, Nurko S, Teitelbaum J E. et al . High-resolution EUS in children with eosinophilic “allergic” esophagitis.  Gastrointest Endosc. 2003;  57 30-36
• 4 Gupta S K, Fitzgerald J F, Chong S K. et al . Vertical lines in distal esophageal mucosa (VLEM): a true endoscopic manifestation of esophagitis in children?.  Gastrointest Endosc. 1997;  45 485-489
• 5 Teitelbaum J E, Fox V L, Twarog F J. et al . Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate.  Gastroenterology. 2002;  122 1216-1225
• 6 Fox V L, Nurko S, Furuta G T. Eosinophilic esophagitis: it’s not just kid’s stuff.  Gastrointest Endosc. 2002;  56 260-270
• 7 Potter J W, Saeian K, Staff D. et al . Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features.  Gastroenterology. 2004;  59 355-361
• 8 Straumann A, Spichtin H P, Simon H U. et al . Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 12 years.  Gastroenterology. 2003;  125 1660-1669
• 9 Arora A S, Perrault J, Smyrk T C. Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults.  Mayo Clin Proc. 2003;  78 830-835
• 10 Coen A, Peterson K, Clark H. et al . Prevalence of GERD and allergy in eosinophilic esophagitis [abstract].  Gastroenterology. 2004;  126 A447
• 11 Khan S, Orenstein S R, Di Lorenzo C. et al . Eosinophilic esophagitis: strictures, impactions, dysphagia.  Dig Dis Sci. 2003;  48 22-29.
• 12 Spergel J M, Beausoleil J L, Mascarenhas M. et al . The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis.  J Allergy Clin Immunol. 2002;  109 363-368
• 13 Arora A S, Yamazaki K. Eosinophilic esophagitis: asthma of the esophagus?.  Clin Gastroenterol Hepatol. 2004;  2 523-530
• 14 Croese J, Fairley S K, Masson J W. et al . Clinical and endoscopic features of eosinophilic esophagitis in adults.  Gastrointest Endosc. 2003;  58 516-522
• 15 Kanwal F, Dry S M, Weinstein W M. Novel histologic findings in the ringed esophagus are the likely basis for the endoscopic features [abstract].  Gastroenterology. 2003;  125 A235
• 16 Kaplan M, Mutlu E A, Jakate S. et al . Endoscopy in eosinophilic esophagitis: “feline” esophagus and perforation risk.  Clin Gastroenterol Hepatol. 2003;  1 433-437
• 17 Lim J R, Gupta S K, Croffie J M. et al . White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children.  Gastrointest Endosc. 2004;  59 835-838
• 18 Straumann A, Spichtin H P, Bernoulli R. et al . Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings.  Schweiz Med Wochenschr. 1994;  124 1419-1429
• 19 Vasilopoulos S, Murphy P, Auerbach A. et al . The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis.  Gastrointest Endosc. 2002;  55 99-106
• 20 Dahl J, Nostrant T T, Greenson J K. Eosinophils in the esophagus: reflux or eosinophilic esophagitis?.  Mod Pathol. 2005;  18 100A
• 21 Attwood S E, Lewis D J, Bronder C S. et al . Eosinophilic esophagitis: a novel treatment using Montelukast.  Gut. 2003;  52 181-185
• 22 Kelly K J, Lazenby A J, Rowe P C. et al . Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula.  Gastroenterology. 1995;  109 1503-1512
• 23 Liacouras C A, Wenner W J, Brown K. et al . Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids.  J Pediatr Gastroenterol Nutr. 1998;  26 380-385
• 24 Liacouras C A. Failed Nissen fundoplication in two patients who had persistent vomiting and eosinophilic esophagitis.  J Pediatr Surg. 1997;  32 1504-1506
• 25 Straumann A, Bauer M, Fischer B. et al . Idiopathic eosinophilic esophagitis is associated with a T(H)2-type allergic inflammatory response.  J Allergy Clin Immunol. 2001;  108 954-961
• 26 Noel R J, Putnam P E, Collins M H. et al . Incidence of eosinophilic esophagitis is increasing in a pediatric population [abstract].  Gastroenterology. 2004;  126 A449
• 27 Attwood S E, Smyrk T C, Demeester T R. et al . Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome.  Dig Dis Sci. 1993;  38 109-116
• 28 Straumann A, Rossi L, Simon H U. et al . Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis?.  Gastrointest Endosc. 2003;  57 407-412
• 29 Desai T K, Stecevic V, Chang C H. et al . Association of eosinophilic inflammation with esophageal food impaction in adults.  Gastrointest Endosc. 2005;  61 795-801
• 30 Winter H S, Madara J L, Stafford R J. Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis.  Gastroenterology. 1982;  83 818-823
• 31 Vieth M, Peitz U, Labenz J. et al . What parameters are relevant for the histological diagnosis of gastroesophageal reflux disease without Barrett’s mucosa?.  Dig Dis. 2004;  22 196-201