Eosinophilic Esophagitis

This chapter reviews all aspects of eosinophilic esophagitis (EoE), including epidemiology, diagnosis, clinical presentation and evaluation, histopathologic features, pathogenesis, natural history, and treatments. EoE can occur at any age, with reports spanning from infants to nonagenarians. EoE could be diagnosed in the setting of clinical symptoms of esophageal dysfunction and esophageal biopsies with at least 15 eosinophils per high-power field, and after excluding gastroesophageal reflux disease with either a high-dose proton pump inhibitors trial or pH monitoring. The symptoms of EoE may come to the attention of primary care physicians, gastroenterologists, allergists, and emergency room physicians. Endoscopic ultrasonographic demonstration of the expansion of the muscularis propria was described in an early case report of an elderly patient with a muscular variant of EoE. EoE is an allergen/immune-mediated disease, and knowledge about the pathogenesis of the disease has increased rapidly. Diet therapy offers an effective, non-pharmacologic treatment option for both children and adults with EoE.