Virginia Baez Socorro
Case Western Reserve University, USA
Title: Eosinophilic Esophagitis: Reflux, protein allergy or both?
Biography
Biography: Virginia Baez Socorro
Abstract
Eosinophilic Esophagitis (EoE) is a disease characterized by a localized inflammatory condition of the esophagus with symptoms of esophageal dysfunction and eosinophil infiltration of the esophageal mucosa. The incidence and prevalence of EoE has increased during the last decade. The symptoms of EoE are age related. In infants and young children common symptoms are failure to thrive, feeding difficulties, and classic symptoms of gastroesophageal reflux. School age children can present with vomiting, abdominal pain, and regurgitation and adolescents with dysphagia and esophageal food impaction. Patients with EoE have higher atopic comorbidities such as asthma, food allergies, allergic rhinitis, and atopic dermatitis. The diagnosis of EoE is completed with upper endoscopy and the finding of more than 15 eosinophils per high-powered microscopic field within esophageal mucosal biopsies. EoE could be treated with medications or diet modification. Oral steroid (e.g. budesonide and fluticasone) therapy is effective in up to 80% of patients with EoE. These medications are swallowed with the goal of topical application to the esophageal mucosa. An elemental diet using a formula lacking antigenic capacity is effective in up to 90% of patients. A specific six-food (milk, egg, wheat, soy, peanut/tree nuts, and fish) elimination diet has a success of 72%, but is difficult for patients. Recently, specific four-food elimination diets have been shown to be effective with better patient acceptance. Allergy-test driven diets are effective only in 45% of patients. A subclass of EoE responds to proton pump inhibitor therapy.