Eosinophilic Esophagitis—A Primer for Otolaryngologists

Educational Objective
To discuss common presenting symptoms, work-up, and treatment of eosinophilic esophagitis for the general otolaryngologist.
Related
Eosinophilic Esophagitis
1 Credit CME
JAMA Otolaryngology–Head & Neck Surgery
April 1, 2019
Review
Article Information and Disclosures
Sanjay Kumar, MD1; Sukgi Choi, MD2; Sandeep K. Gupta, MD3,4 Author Affiliations Read article on JAMA Network
MOC/CME Information

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Abstract
Importance  Eosinophilic esophagitis (EoE) is a chronic, inflammatory condition of the esophagus. Prevalence of EoE is on the rise and, owing to its associated extragastrointestinal manifestations and comorbidities, otolaryngologists are increasingly encountering this condition in their practice.

Observations  Symptoms of EoE are vague and vary greatly based on patient’s age. The gastrointestinal symptoms include dysphagia, food impaction, feeding difficulties, symptoms mimicking gastroesophageal reflux, abdominal pain, vomiting, and failure to thrive. Several otolaryngologic symptoms are associated with EoE including rhinosinusitis, chronic cough, recurrent croup, hoarseness, and other aerodigestive symptoms refractory to gastroesophageal reflux therapy. Eosinophilic esophagitis is also frequently associated with other atopic conditions, such as asthma, eczema, and food allergies. The diagnosis is made on endoscopy with biopsies that reveal eosinophil-predominant esophageal inflammation. There are 3 major treatment approaches to EoE, commonly referred to as the 3 Ds: diet, drugs, and dilation. Untreated inflammation of esophagus from EoE can result in irreversible structural damage to the esophagus, leading to fibrosis, strictures, and impaired esophageal function.

Conclusions and Relevance  Eosinophilic esophagitis is now a fairly prevalent condition with considerable morbidity. Otolaryngologists should be familiar with the various clinical presentations of this condition in different age groups. Early diagnosis and treatment of this condition is a key for avoiding or postponing its complications.