Esophageal food impaction can be the initial presentation of PPI-responsive eosinophilic esophagitis. A study that compared the initial presenting symptoms of eosinophilic esophagitis reported that women more commonly presented with heartburn, whereas men more commonly presented with dysphagia and food impaction, although no endoscopic differences were noted between the sexes. Most patients with eosinophilic esophagitis are white men. In general, the clinical symptoms of eosinophilic esophagitis are nonspecific, and the patients are in good physical condition; therefore, in some cases, the diagnosis of eosinophilic esophagitis is made a few years after onset of symptoms.
Esophagogastroduodenoscopy with biopsy confirms the diagnosis of eosinophilic esophagitis. Radiographic studies are not routinely performed for diagnosis of eosinophilic esophagitis, owing to low sensitivity. Fluoroscopic studies may help in the setting of subtle findings and for evaluation of fibrotic remodeling changes.
The treatment of eosinophilic esophagitis continues to evolve. Various interventions, such as complete avoidance of precipitating food allergens, esophageal dilatation, corticosteroids, cromolyn sodium, and leukotriene inhibitors, have been used. The ACG has issued guidelines for the diagnosis and management of eosinophilic esophagitis. Recommendations for treatment included the following:
Topical swallowed steroids are considered a first-line treatment.
Elimination of possible triggering foods from the diet can be an initial treatment for pediatric and adult patients.
Patients should be informed that once treatment has stopped, there is a high risk that eosinophilic esophagitis will recur.
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Cite this: B.S. Anand. Fast Five Quiz: Esophagitis - Medscape - Jul 14, 2020.