Eosinophilic esophagitis

Table 1 Clinical presentation of eosinophilic esophagitis

Gastrointestinal symptoms	Other symptoms
Dysphagia	Chest pain
Food impaction	Rhinitis
Nausea and vomiting	Asthma
Heartburn	Allergies
Abdominal pain	Atopic dermatitis
Feeding disorders (pediatric)	Hoarseness
Failure to thrive (pediatric)	Croup, cough
	Sleep disordered breathing

Table 2 Clinical signs in eosinophilic esophagitis

Endoscopic features	Histologic features
Diminished vascular pattern	Thick epithelium with eosinophilia
Mucosal furrows	Abnormally long papillae
Thick mucosa	Fibrotic lamina propria
Exudates	Microabscesses
Strictures	Extracellular Eosinophilic granules
Rings	Increased extracellular major basic protein (MBP)
Laryngeal edema, vocal cord nodules, laryngeal ventricular obliteration

Table 3 Complications in EE related to disease and to the interventions performed for treatment

Complications of EE	Complications of therapeutic interventions
Acute food impactions	Mucosal rents/tears
Long and short segment narrowing	Perforation
Stenosis	Infections-due to chronic use of steroids
GERD	Nutritional deficiencies
Boerhaave’s syndrome
Nutritional deficiencies

Table 4 Diagnostic guidelines for eosinophilic esophagitis

Eosinophilic esophagitis
Symptoms (adults)	GERD refractory to medical therapy
	Dysphagia
	Food Impaction
	Retrosternal chest pain
Endoscopy	Mucosal furrows
	Exudates
	Esophageal lumen narrowing
	Rings
Histology	Esophageal biopsies ≥15 eosinophils/HPF
	Biopsies obtained after 6-8 wk of bid PPI therapy or patients must have a documented negative pH study
	Normal biopsies in the rest of the GI tract