[Eosinophilic esophagitis: a novel entity?]

Eosinophilic esophagitis (EE), first recognized as a unique entity somewhat more than 10 years ago, is a chronic, TH2-type inflammatory disorder of the esophagus. The diagnostic criterion is a peak infiltration of the esophageal epithelium with >24 eosinophils/HPF. The inflammatory pattern consists of eosinophils, T-cells and mast cells, together with increased expression of IL-5 and TNF-alpha. Though originally believed extremely rare, EE is increasingly recognized and its prevalence may soon equal chronic inflammatory bowel diseases. The main symptom of EE is dysphagia for solid foods with imminent risk of food impaction. Endoscopic abnormalities are varied but discreet, with reddish furrows being the most frequent and white exudates being the most prominent sign. The main long-term risk of EE is the induction of fibrosis with subsequent esophageal stricture. Therapeutic recommendations include systemic or topical corticosteroids, leukotriene antagonists, hypo-allergic diets and dilation.