Good review: Glenn T. Furuta, M.D., and David A. Katzka, M.D. N Engl J Med 2015; 373:1640-1648
A couple pointers from this review:
- Estimated prevalence of eosinophilic esophagitis (EoE) 0.4% in Western countries. Symptoms are often underestimated due to patient ‘accommodation’ which includes eating slowly/carefully, drinking a lot of liquids and avoiding items more prone to become lodged (meats, pills, breads)
- Pathogenesis: “Birth by cesarean section, premature delivery, antibiotic exposure during infancy, food allergy, lack of breast-feeding, and living in an area of lower population density have all been associated with eosinophilic esophagitis.”
- Impaired barrier function and enhanced the activity play a role in pathogenesis
- Food allergy is a non-IgE-mediated process. Omalizumab, an anti-IgE biologic, is ineffective in EoE and EoE can develop in IgE-null mice
- Male predominance (3:1) suggests that there is a genetic component.
Another useful reference on Eosinophilic Gastritis in Children: Am J Gastroenterol 2014; 109; 1277-85. This article provides data on clinical and histologic remission with eosinophilic gastritis (>70 eos/hpf), n=30 children. “Response to dietary restriction was high” (82% clinical, 78% histologic response) Thanks to Seth Marcus for this reference.
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