21 February 2020 What is eosinophilic esophagitis? Eosinophilic esophagitis , also known as allergic esophagitis, is a chronic inflammatory disease of the esophagus characterized by: eosinophils present in the inner lining (mucosa) of this organ, symptoms of esophageal dysfunction. Eosinophils are one of the types of white blood cells and are implicated in the responses of the immune system. What are the symptoms of eosinophilic esophagitis? Eosinophilic esophagitis has no specific symptoms. The disease symptoms vary widely with patients age . Infants / preschoolers : weight progression compromised, food regurgitation, vomits and refusal to eat are the most frequent manifestations. School-age children : food regurgitation, vomits, abdominal pain and burning sensation in the thoracic region characterize the usual clinical presentation. Adolescents and adults : food impaction episodes, intermittent swallowing difficulty and chest pain are typical complaints. The presentation of the disease with an episode of severe food impaction requiring endoscopic removal of food is frequent, mainly in adolescence. Often there is a difficulty in swallowing with mild and intermittent and with prolonged evolution. Many patients report symptoms with years of evolution, which have been ignored, compensated or related to occasional problems like not chew food well or do it too quickly. Who can suffer from eosinophilic esophagitis? Eosinophilic esophagitis can affect any age group , from children to adults. What causes eosinophilic esophagitis? Eosinophilic esophagitis results from genetic and environmental factors . A family predisposition for the disease has been described. The implication of food allergy in eosinophilic esophagitis has been justified based on: high frequency of food sensitization found among these patients; evidence of the clinical and histological response following food avoidance diets, especially in children, found in several clinical studies; recurrence of symptoms with food reintroduction, proving the causal relationship between eosinophilic esophagitis and food. What foods are involved in eosinophilic esophagitis? The foods usually implicated in eosinophilic esophagitis are cow milk; egg; soy; peanuts; dry fruits; wheat; fish; seafood (crustaceans and molluscs). Cases are reported of patients with respiratory allergy and sensitization to pollens that refer symptoms of eosinophilic esophagitis worsening during the pollen season . There is also seasonal variation in the incidence of the disease, with the lowest diagnostic rates during winter, which suggests the participation of aeroallergens in the development of this disease . How is the diagnosis of eosinophilic esophagitis made? The diagnosis of eosinophilic esophagitis is clinical and histological . Diagnostic criteria are: the presence of symptoms of esophageal dysfunction; the result of an esophageal biopsy with 15 or more eosinophils per high power field (400x). Upper digestive endoscopy is an essential diagnostic test . It allows to observe the esophageal mucosa and perform biopsies. The biopsy of the esophageal mucosa should cover the entire length of the organ, and it is advisable to obtain 6 samples. In eosinophilic esophagitis, infiltration of the esophageal mucosa by eosinophils is an isolated phenomenon , that is, the mucosa of the remaining organs of the upper gastrointestinal tract is not affected. Thus, in the diagnostic approach of a possible eosinophilic esophagitis, biopsies of the gastric mucosa and duodenal mucosa should be performed, and their results should be normal. Otherwise, the diagnostic hypothesis of eosinophilic esophagitis must be reconsidered. Allergology assessment of the patient is important after histological confirmation of eosinophilic esophagitis diagnosis to identify food allergens potentially implicated in the disease. Sensitization to inhaled allergens should still be evaluated , given its high frequency and possible implication in the patient approach. The laboratory evaluation of these patients has no diagnostic value, but there are parameters that may be informative. pH monitoring, contrast radiography and / or esophageal manometry are not part of the diagnostic approach but may be justified in some patients. How is eosinophilic treated? The treatment of eosinophilic esophagitis is based on: elimination of the allergenic stimulus; symptom control; induction of prolonged remission of the disease. There are 3 types of possible interventions : intervention in the diet; pharmacological treatment; endoscopic treatment, reserved for extreme and emergent situations (severe food impaction or esophageal stricture). The authors of this text are the following allergologists from the Hospital da Luz network: Luís Miguel Borrego, Ana Morais Mendes, Ana Reis Ferreira, Andreia Ferrão, Carlos Braga, Cristina Lopes, Diana Pereira da Silva, Filipa Semedo, Isabel Costa Silva, João Gaspar Marques, Pedro Carreiro Martins, Marta Salgado, Nuno Sousa, Rosa Anita Fernandes, Susana Piedade The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
