Eosinophilic esophagitis

From Ask Dr Wiki

Eosinophilic esophagitis is an allergic inflammatory condition of the esophagus. Symptoms are chest pain or heartburn and occasionally dysphagia, or difficulty in swallowing. The disease was first described in children but occurs in adults as well.

Diagnosis is obtained during an upper GI endoscopy where biopsies are taken of the esophagus. At the time of endoscopy, ridges or furrows may be seen in the esophagus wall. Sometimes, multiple rings may occur in the esophagus, leading to the term "multi-ring esophagus" or "feline esophagus" due to the similarity in the rings of the cat esophagus. A high number of eosinophils are seen on microscopic examination of the biopsy specimens. Skin testing can help identify which foods might contribute to this disease, but often skin testing implicates foods that are not involved. Common allergens in the GI tract are cow's milk, soy, egg and wheat.

Treatment strategies include removal of the offending food, proton pump inhibitors to decrease acidity in the stomach that may reflux into the esophagus, inhaled steroid puffers taken orally and swallowed, anti-histamines, H2-receptor blockers such as cimetidine, leukotriene modifiers such as montelukast, and, in investigational reports, the anti-IL5 monoclonal antibody mepolizumab. Refractory patients may require oral steroid medications.

External links

• American Partnership for Eosinophilic Disorders
• Cincinnati Center for Eosinophilic Disorders

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Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis)

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	Esophagus	Esophagitis - GERD - Achalasia - Boerhaave syndrome - Nutcracker esophagus - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus
Stomach/ duodenum	Peptic (gastric/duodenal) ulcer - Gastritis - Gastroenteritis - Duodenitis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy
Hernia	Inguinal (Indirect, Direct) - Femoral - Umbilical - Incisional - Diaphragmatic - Hiatus
Noninfective enteritis and colitis	IBD (Crohn's, Ulcerative colitis) - noninfective gastroenteritis
Other intestinal	vascular (Abdominal angina, Mesenteric ischemia, Ischemic colitis, Angiodysplasia) - Ileus/Bowel obstruction (Intussusception, Volvulus) - Diverticulitis/Diverticulosis - IBS other functional intestinal disorders (Constipation, Diarrhea, Megacolon/Toxic megacolon, Proctalgia fugax) - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis (Radiation proctitis)
Liver/hepatitis	Alcoholic liver disease - Liver failure (Acute liver failure) - Cirrhosis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome
Accessory digestive	Gallbladder (Gallstones, Choledocholithiasis, Cholecystitis, Cholesterolosis, Rokitansky-Aschoff sinuses) Biliary tree (Cholangitis, Cholestasis/Mirizzi's syndrome, PSC, Biliary fistula, Ascending cholangitis) Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis)
Other/general	Appendicitis - Peritonitis (Spontaneous bacterial peritonitis) Malabsorption (celiac, Tropical sprue, Blind loop syndrome, Whipple's) postprocedural: Gastric dumping syndrome - Postcholecystectomy syndrome bleeding: Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower)
	See also congenital

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