Eosinophilic esophagitis: Its role in aerodigestive tract disorders

Eosinophilic esophagitis is a unique clinicopathologic entity that has slowly gained attention over the past decade but has not been well recognized in the field of otolaryngology. The precise cause of the disease is unknown but is likely associated with food and environmental allergic antigens. Both IgE-mediated and non-IgE-mediated mechanisms are involved in the pathophysiology of the disease. Otolaryngologists should be familiar with the presentation because many patients experience concomitant pharyngolaryngeal and airway symptoms. As the otolaryngologist's role in the evaluation and management of esophageal disease continues to expand, it will be imperative to consider EE as a potential diagnosis among young children with feeding disorders and adolescents and adults with dysphagia. Esophagoscopy with biopsies of the proximal, mid, and distal esophagus are essential in diagnosing EE. Food allergy testing (RAST or skin prick or patch) may be helpful in identifying possible causative agents that should be restricted or eliminated. Peripheral eosinophil counts and IgE, although frequently elevated, are less specific for the disease. Swallowed or inhaled corticosteroids have been shown to be effective and well tolerated, but other options exist for refractory cases.