Eosinophilic esophagitis in adults: What is the clinical significance?

Eosinophilic esophagitis is a condition that is being increasingly recognized in adults. The main presenting symptoms are dysphagia (93%), food impaction (62%), and heartburn (24%). A history of allergy is obtained in 52% of patients and peripheral eosinophilia is found in 31% of patients with this condition. Esophageal manometric studies have provided evidence of a nonspecific motility disorder in 40% of patients. Endoscopic findings include mucosal fragility or edema (59%), solitary or multiple concentric rings (49%), strictures (40%), whitish pinpoint exudates or papules (16%), and a small-caliber esophagus (5%); 9% of patients present with a normal endoscopy. Esophageal dilation in adults with eosinophilic esophagitis has limited efficacy and is associated with an increased complication rate compared with dilation in patients with benign strictures. The administration of inhaled or systemic corticosteroids results in symptomatic improvement in nearly 95% of patients. A trial with corticosteroids before bougienage may reduce active inflammation and therefore the complication rate of the procedure.