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Eosinophilic Esophagitis Review -NEJM

December 7, 2015 7:00 am

Good review:  Glenn T. Furuta, M.D., and David A. Katzka, M.D. N Engl J Med 2015; 373:1640-1648

A couple pointers from this review:

• Estimated prevalence of eosinophilic esophagitis (EoE) 0.4% in Western countries.  Symptoms are often underestimated due to patient ‘accommodation’ which includes eating slowly/carefully, drinking a lot of liquids and avoiding items more prone to become lodged (meats, pills, breads)
• Pathogenesis: “Birth by cesarean section, premature delivery, antibiotic exposure during infancy, food allergy, lack of breast-feeding, and living in an area of lower population density have all been associated with eosinophilic esophagitis.”
• Impaired barrier function and enhanced the activity play a role in pathogenesis
• Food allergy is a non-IgE-mediated process.  Omalizumab, an anti-IgE biologic, is ineffective in EoE and EoE can develop in IgE-null mice
• Male predominance (3:1) suggests that there is a genetic component.

Esophagus with ringed appearance, furrowing, and loss of vascular markings

Another useful reference on Eosinophilic Gastritis in Children: Am J Gastroenterol 2014; 109; 1277-85.  This article provides data on clinical and histologic remission with eosinophilic gastritis (>70 eos/hpf), n=30 children.  “Response to dietary restriction was high” (82% clinical, 78% histologic response) Thanks to Seth Marcus for this reference.

Related blog posts:

• Looking Twice for Eosinophilic Esophagitis | gutsandgrowth
• Higher Doses of Topical Steroids for Eosinophilic Esophagitis
• Eosinophilic Esophagitis Slide Set | gutsandgrowth
• How Common is Eosinophilic Esophagitis? | gutsandgrowth
• Systemic Review of Dietary Treatments… | gutsandgrowth
• Do We Still Need PPI-REE? | gutsandgrowth
• Sweet Alternative to Splenda for Budesonide | gutsandgrowth

Posted by gutsandgrowth

Categories: Pediatric Gastroenterology Intestinal Disorder

Tags: Eosinophilic esophagitis, eosinophilic gastritis, food allergy, pathogenesis, prevalence

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4 Responses to “Eosinophilic Esophagitis Review -NEJM”

1. […] Eosinophilic Esophagitis Review -NEJM | gutsandgrowth […]

   By Good Press for PPIs | gutsandgrowth on January 26, 2016 at 7:01 am

2. […] Eosinophiliic Esophagitis NEJM Review -post also includes information on eosinophilic gastritis […]

   By Epidemiology of Eosinophilic Disorders | gutsandgrowth on February 26, 2016 at 7:01 am

3. […] Eosinophilic Esophagitis Review -NEJM | gutsandgrowth […]

   By Eosinophilic Esophagitis: the Limits of “Clinical Remission” | gutsandgrowth on March 31, 2016 at 7:04 am

4. […] Eosinophilic Esophagitis Review -NEJM | gutsandgrowth […]

   By Pediatric Nutritionist/Scott Pentiuk: Update on two topics: Blenderized diets and Eosinophilic Esophagitis | gutsandgrowth on July 31, 2016 at 9:01 am

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