Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
Purpose: Eosinophilic esophagitis is a chronic inflammatory disorder of the esophagus characterized by heavy infiltration of eosinophils of the esophagus. The etiology, pathogenesis, natural history and optimal treatment of eosinophilic esophagitis in adults are unknown. Here we present the largest case series of eosinophilic esophagitis in adults to date, and to provide evidence that eosinophilic esophagitis in adults is related to gastroesophageal reflux disease (GERD).
Methods: In our group practice of 20 gastroenterologists, we identified a total of 61 consecutive adult patients with a histological diagnosis of eosinophilic esophagitis from our pathology database between 2002 and 2004. The medical records of these patients were reviewed. Data on clinical presentation, endoscopic findings, treatment, and response to treatment were collected and analyzed.
Results: Among the 61 patients with a histological diagnosis of eosinophilic esophagitis, 38 patients (60%) presented with solid food dysphagia and 12 patients (20%) had a history of food impaction. Twenty-five patients (41%) presented symptoms of GERD, either with (14 patients) or without (11 patients) concurrent dysphagia, as their main complaints. The classical endoscopic finding of ringed esophagus was present in only 32 patients (52%), and 8 patients (13%) had normal esophagus at endoscopy. In parallel with the abundance of clinical symptoms of GERD, endoscopic findings associated with GERD were common, with hiatal hernia present in 30 patients (49%), reflux esophagitis in 11 patients (18%), peptic stricture in 4 patients (7%), and Barrett's esophagus in 2 patients. While esophageal dilation, either alone or in conjunction with treatment with a proton pump inhibitor (PPI), was effective in relieving dysphagia, medical treatment with a PPI alone without dilation also resulted in resolution of dysphagia in all 9 patients whose follow-up information was available.
Conclusions: The presence of clinical and endoscopic features of GERD and the response to treatment with proton pump inhibitors in many of our patients strongly implicate GERD in the pathogenesis of eosinophilic esophagitis in adults. In adult patients with eosinophilic esophagitis who present with dysphagia, we suggest treatment with a PPI before performing esophageal dilation.