SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

9/12/05

Idiopathic, eosinophilic esophagitis in adults

Summary
Background - Idiopathic eosinophilic esophagitis (IEE) has been considered to be a primarily pediatric disorder associated with food allergies and other factors. However, it has been more recently recognized that IEE occurs in adults as well.

Findings - Zimmerman et al of the Hospital of the Univ of Pennsylvania retrospectively reviewed the clinical and radiologic findings in 14 adults with IEE (at least 20 eosinophils/HPF in esophageal biopsies). There was a history of allergies in 7 of the 14 patients with peripheral blood eosinophilia in 2 of 9 subjects in this group. Dysphagia was present in 93%, impaction in 43%, and GERD-type symptoms in 43%. In barium studies, strictures were found in 10 patients, occurring at varying locations within the esophagus. A “ringed esophagus” pattern was seen in 7 patients. In recumbent radiologic studies, there was evidence of reflux in 69%.

Endoscopic dilatations were attempted in 8 of the 10 IEE patients with strictures. Only temporary relief of dysphagia was achieved.

Reference
 Radiology 2005;236:159-65

Editor's Comments
These findings highlight the need to consider IEE in the causes of dysphagia/food impaction in adults. Studies of IEE in children suggest that early oral administration of corticosteroids such as fluticasone (ordinarily used for inhaled therapy in asthma) may be quite beneficial with little or no systemic steroid toxicity. Such early topical steroid therapy may prevent the strictures described above.

 

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