Eosinophilic esophagitis Presented by Chuleeporn Kongmeesook, MD, 2013

1. Eosinophilic
Esophagitis
CHULEEPORN KONGMEESOOK ,MD

2. Outline
• Prevalence
• Diagnosis
• Clinical presentation
• Endoscopic and Histologic finding
• Management

3. Definition
A chronic, immune/antigen-mediated
esophageal disease characterized
• Clinically by symptoms related to
esophageal dysfunction
• Histologically by eosinophil-predominant
inflammation
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

4. • Non-Hispanic
• White
• Atopic males (male/female ratio 3:1)
• Onset in childhood or during the third or
fourth decades of life
• Incidence 0.7-10 per 100,000 per
person-year
• Prevalence 0.2-43 per 100,000
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

5. Diagnosis
• Symptomatic patients after a biopsy that
confirms 15 Eos/HPF
• At least one esophageal level
(eg, distal, proximal)
• In whom acid reflux has been ruled out
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

6. Eosinophil associated esophagitis
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

7. Clinical Manifestation
Mirna Chehade et al Aceves Current Opinion in Allergy and Clinical Immunology 2010;10:231-237

8. • Any pt with symptoms suggestive of EoE
should undergo careful history focus on
eating and swallowing habits
• Children and adults with EoE often rapidly
adapt eating habits to manage their
impaired esophageal function
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

9. Endoscopic Finding
• Esophageal endoscopy with biopsy 
reliable diagnostic test for EoE
• Appropriate clinical setting + any
endoscopic finding supports but not
establish the Dx of EoE
• 2-4 mucosal specimens of the proximal
and distal esophagus should be obtain
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

10. ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

11. Radiography
• Not a recommended routinely
• Helpful in selected cases
anatomic abnormalities difficult to
endoscope esophageal strictures
(length and diameter)
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

12. Histologic Finding 1
• At least 15 Eos/hpf in the maximally
affected esophageal tissue
• Histopathologic features of esophageal
mucosal biopsy must be interpreted in
with the patient’s clinical information
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

13. Histologic Finding 2
• EoE might be focal and not be present in
all biopsy specimens
• Peak number of Eos/hpf as average
number
• Site and number of biopsy  Affect
Eos count
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

14. ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

15. • Esophageal pH monitoring (and pH
impedance ) useful diagnostic test to
evaluate for GERD in pts with esophageal
eosinophilia
• Peripheral eosinophil counts pts with
EoE 40-50% having increased numbers of
circulating Eos (>300-350 /mm3)
• Total IgE inadequate data to support the
utility of measuring total IgE level as a
surrogate disease in pts with EoE
ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

16. Management
Corticosteroid therapy
• Increase eosinophil apoptosis
• Downregulate eosinophil chemotaxis
• Inhibit proinflammatory cytokines that
promote eosinophil survival and activation
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

17. Management
Systemic oral corticosteroid
• Induce remission of EoE symptoms and
both gross and histologic features
• Long-term steroid adverse effects and
relapse after discontinuation
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

18. Management
Topical corticosteroid
• Modulation of esophageal gene expression
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

19. ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20

20. Management
Dietary therapy
• Elemental dietary therapy
• Targeted dietary elimination
• Empiric dietary elimination
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

21. Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

22. Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

23. Conclusions
Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40

24. THANK
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