1. Outpatient Case Presentation
Dean Keller, M.D.
GIM Conference

2. Objectives
To present a “newer” disease entity through a case presentation and review of the literature
No financial disclosure

3. Eosinophilic Esophagitis-Essentials of diagnosis
Clinical symptoms of esophageal dysfunction
Esophageal mucosal biopsy containing greater than 15 intraepithelial eosinophils per HPF
Lack of response to PPI

4. Symptoms and Signs
Most common is intermittent dysphagia and food impaction in young adults
Esophageal stricture
Nausea, vomiting, regurgitation
Heartburn
Absence of red flags

5. Lab and Endoscopic Findings
Mild peripheral eosinophilia in 5-50%
Dense eosinophilic infiltrates on esophageal biopsy of squamous epithelium
Endoscopic features linear furrowing, circular rings, strictures, crepe paper mucosa, white exudates
Stricture: proximal, middle, or distal

7. Treatment
Newer disease entity-most evidence is grade c (clinical experience, descriptive studies, reports of experts committees)
Dilation of strictures-longitudinal tears but no perforation-good response
Fluticasone 220mcg 4 puffs swallowed daily for 6 weeks
Elimination diets not helpful in adults

8. Follow up and Prognosis
Maintenance treatment has not been studied
Repeat endoscopy based on recurrent symptoms
7.2 years of f/u on 30 adults 11/30 required dilation
No increase risk of malignancy or Barrett’s changes over 11 year f/u period

9. References
Yan BM, Shaffer EA. Eosinophilic esophagitis: A newly established cause of dysphagia. World J Gastroenterol 2006;12(15):
Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: A systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133: