Eosinophilic Esophagitis or Asthma of the Esophagus: First Case Series Report From Chile

Abstract

Introduction: Eosinophilic esophagitis (EE) is a recently described idiopathic clinico-patological entity seen mainly in children and young adults associated with recurrent disphagia and episodes of food impaction. It is characterized endoscopically by a ringed esophagus and histologically by a dense epithelial eosinophilic infiltration (> 24 eosinophils per high-power field) (HPF). Objectives: To describe the clinical, endoscopic and histopathological characteristics and therapy response of a cohort of Chilean adult patients with EE recently diagnosed in our Center. Methods: We describe 7 consecutive adult patients with EE seen at our Center between August 2003 and August 2004. During this period a total of 4356 upper GI endoscopies were performed due to many causes. Results: Of all upper GI endoscopies performed during 8/2003-8/2004, 0.16% (7/4356) had confirmed EE. Other 3 patients had endoscopic ringed esophagus with histopathology not confirming EE (0-3 eosinophils por HPF). All EE patients were men with a mean age of 34.7 years (range (22-58 years-old). 85.7% had dysphagia, 71.4% had previous episodes of solid food impaction and acid reflux was a common associated symptom (85.7%). None of them had history of atopy or asthma. 25.8% had peripheral eosinophilia and 42.8% had elevated IgE levels. The mean eosinophil infiltration of the biopsied esophageal mucosa was 56.4 (range 25-110 per HPF). In four cases the stomach was also biopsied without showing eosinophil infiltration of the mucosa. In 71.4% the skin tests showed evidence of allergies to different foods. Therapy included food restrictions (diet) and steroids (oral or inhaled/degluted). The response during the first 6-12 months has been variable with good overall response after steroids either topical or systemic. Conclusions: Eosinophilic esophagitis is an uncommon clinical entity associated with disphagia and recurrent episodes of solid-food impaction seen predominantly in young male adults. The knowledge of this entity may rise the clinical suspicion of this diagnosis in patients with recurrent esophageal symptoms prompting to biopsy the esophageal mucosa to demonstrate the typical dense infiltration of eosinophils. In our case series report 7/10 patients with an evident ringed esophagus seen out of 4356 upper GI endoscopies, had finally a confirmed EE. The therapy including diet restrictions and steroids (whether topical or systemic) may improve temporarily these symptoms.