Eosinophilic Esophagitis: An Emerging Allergic Disorder Affecting the Esophagus
Symptoms of Eosinophilic Esophagitis
The classic and most common symptoms of EoE include dysphagia or difficulty in swallowing and food impaction. Apart from this, patients may also experience symptoms like abdominal pain, heartburn, chest pain, vomiting and weight loss. However, many patients may remain asymptomatic or may report symptoms commonly seen in gastroesophageal reflux disease (GERD) like acid reflux. The symptoms often worsen with time if left untreated.
Diagnosis of Eosinophilic Esophagitis
Eosinophilic Esophagitis is diagnosed by performing upper endoscopy along with biopsy of the esophagus. During endoscopy, esophageal mucosa may show signs of superficial furrows, ridging and narrowing of the lumen. However, endoscopic findings are not always diagnostic. Histological findings are crucial for diagnosis which show >15 eosinophils per high power field in one or more biopsy specimens from esophagus. Other potential causes of esophageal eosinophilia need to be ruled out.
Causes and Pathophysiology of Eosinophilic Esophagitis
EoE is considered as a chronic immune/antigen-mediated disease where certain food proteins or aeroallergens trigger an aberrant immune response in the esophagus. Such inciting agents are referred to as triggers. In atopic individuals, these triggers activate T-helper 2 (Th2) lymphocytes and mast cells leading to production of Th2 cytokines. This causes local eosinophilic inflammation and esophageal tissue remodeling. Genetic predisposition also plays a role in EoE as it commonly occurs in families.
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