Eosinophilic esophagitis: An increasingly recognized cause of dysphagia, food impaction, and refractory heartburn

Eosinophilic esophagitis is an increasingly recognized cause of a variety of esophageal symptoms, including dysphagia, food impaction, atypical chest pain, and heartburn that does not respond to medical therapy. Its cause is unknown, but allergic and immunemediated mechanisms similar to those of asthma and other atopic diseases are implicated. KEY POINTS The diagnosis is made with upper endoscopy and esophageal biopsies that show diffuse infiltration of eosinophils. Current treatment in adults is limited and consists of either swallowed fluticasone (Flonase) or a proton pump inhibitor. Because many patients with eosinophilic esophagitis have atopic disease, a complete evaluation for dietary allergens and aeroallergens is recommended, as avoidance of these allergens may be helpful in some adults. Cautious endoscopic dilation is a treatment option in patients with evidence of esophageal stenosis. Systemic corticosteroids and novel biologic therapy have been used in refractory cases.