Allergy and Asthma Source

Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach. Eosinophilic esophagitis patients present with gastric reflux symptoms (heartburn, chest pain, vomiting, regurgitation, abdominal pain) in addition to difficulty swallowing and/ or food impaction and are found on biopsy of the esophagus to have high number of eosinophils (greater than 15-20 per high power field) without infiltration of the rest of the gastrointestinal tract.

Eosinophils are a type of white blood cell which play an important role in immune function, mainly as a defense against against parasites, but are also involved in diseases like allergies and asthma.
People with eosinophilic esophagitis usually have a personal or family history of allergic disease such as hayfever, asthma, or eczema. They present with difficult to treat reflux symptoms, and often food impaction in teens or young adults. Upper endoscopy can show linear furrows, mucosal rings, strictures, or appear normal.

The diagnosis is established by obtaining multiple (at least 5) biopsy specimens of the esophagus which show increased eosinophils (15-20/hpf) in the mucosa only, with none in the stomach or duodenum.
The exact etiology of eosinophilic esophagitis is not yet known, but food and environmental allergies are possible contributors. Short-term studies of the natural history of the disease show no concomitant eosinophilic infiltration of stomach or duodenum, no progression to hypereosinophilic syndrome or development of malignancy.
Food Allergy testing via prick and atopy patch skin test have been used to identify relevant food allergens to guide elimination diets.

Treatment consists of elimination diets, topical corticosteroids, and systemic corticosteroids.

LINKS:

Center for Pediatric Eosinophil Disorders
Resources for Families
More Resources for Families dealing with Eosinophilic Disorders
American Partnership for Eosinophilic Disorders (APFED)
Allergy and Asthma Consultants of Rockland and Bergen
Neocate