SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

10/11/06

Eosinophilic esophagitis, reviewed

Summary
Background - Eosinophilic esophagitis (EE) is an increasingly recognized disorder of both children and adults characterized by symptoms such as food refusal, vomiting, heartburn, dysphagia and sometimes food impaction unresponsive to proton pump inhibitor (PPI) therapy. Esophageal biopsies show a marked accumulation of eosinophils.

Findings - Studies of the possible pathogenesis and treatment of EE were reviewed by Furuta and Straumann of the Boston Children's Hospital. The eosinophilic inflammatory response in EE may be mediated by the cytokines IL-5 and eotaxin-3 (the latter a potent eosinophil chemoattractant). Food allergy appears to play a role in many, but not all, cases of EE. The natural history of EE is not yet clear although esophageal strictures may be a potential complication.

Management of EE includes: 1) elimination of suspect foods when such are identified as potential offenders; 2) an elemental diet in children with multiple documented food allergies; 3) topical corticosteroids (ingested "soft" steroids such as fluticasone or budesonide; 4) systemic corticosteroids when absolutely needed.

Reference
Aliment Pharmacol Ther 2006;24:173-82

Editor's Comments
Some of the patients now diagnosed as having EE were originally considered to have GERD with subsequent unsatisfactory improvement during PPI therapy. A fascinating observation by Rothenberg's group in an experimental model of EE is that challenge with aeroallergens in animals sensitized to such allergens may trigger what looks like EE.

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