Approach to Dysphagia in the Young Patient in the Era of Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) has emerged as an important cause of dysphagia and food impactions in young adults. Previously considered a rare condition, an increasing number of cases of EoE have been attributable to a rising incidence and a growing awareness of the condition. Typical endoscopic features include concentric mucosal rings, linear furrowing, white exudates, and a narrow caliber esophagus. Current consensus guidelines define EoE by 1) the presence of characteristic symptoms, especially dysphagia and food impactions in adults, 2) >or= 15 eosinophils per high power field in esophageal tissue, and 3) exclusion of other disorders with similar presentations (eg, gastroesophageal reflux disease). Current knowledge about the pathophysiology implicates food allergens, aeroallergens, and genetic factors. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. Endoscopic dilation may be performed in patients who do not respond to medical therapy. This review highlights recent insights into the diagnosis and management of EoE in young adults.