EOSINOPHILIC ESOPHAGITIS: AN IMPORTANT CAUSE OF DYSPHAGIA IN THE ADULT

RD Abaskharoun, W Paterson, D Hurlbut

GI Diseases Research Unit, Departments of Medicine and Pathology, Queen's University, Kingston, Ontario

INTRODUCTION: Eosinophilic esophagitis (EE), characterized histologically by large numbers of mucosal eosinophils (>15-20/hpf), has been recognized as a distinct pediatric disease entity. Clinical presentation in children includes symptoms of dysphagia and reflux disease without evidence of peptic acid induced esophagitis. In contrast, EE is not as well established as a possible cause of dysphagia in adults. The objective of this study was to characterize the clinical features and endoscopic findings of EE in adults.
METHODS: Retrospective case review of all patients with biopsy proven EE presenting to a referral gastroenterology service during a 12 month period (11/01 - 10/02). Clinical presentation and endoscopic findings were reviewed.
RESULTS: Chart review identified 10 patients (8M; 2F) with histologic features of EE on esophageal mucosal biopsy. Ages ranged from 12-37 years, with 8 (80%) adult patients [age > 18 years]. All adult patients complained of symptoms of solid food dysphagia and 7 of these patients (88%) presented with food bolus obstruction. Esophageal stricture rate was 40%. Endoscopic findings included characteristic "multiple rings" in 40% of cases.
CONCLUSION: Eosinophilic esophagitis is an under-recognized cause of solid food dysphagia in adults. Adult patients presenting with symptoms of solid food dysphagia and/or food bolus obstruction should be routinely biopsied for the possibility of EE, unless another cause of dysphagia is readily apparent.