Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder that is characterized by a dense infiltration of eosinophils in the wall of the esophagus. Eosinophils are white blood cells that are involved in certain allergic conditions. Patients with EoE typically complain of solid food getting stuck in their throat or chest upon swallowing. Since these patients may also experience heartburn, nausea and chest pain, they are often misdiagnosed as having GERD (although the two conditions may coexist). Patients with EoE experience trouble swallowing due to the esophageal strictures and rings that develop as a result of the eosinophilic infiltration. The esophageal findings of EoE, which include linear furrows, multiple rings and fine white exudates, may be subtle and are often unrecognized at the time of endoscopy.
The diagnosis of EoE is made by obtaining biopsies from several locations in the esophagus and finding more than 15-20 eosinophils per high power field under the microscope. The cause of EoE is thought to be an allergy to a swallowed or inhaled allergen and/or gastroesophageal reflux disease. Therapy for eosinophilic esophagitis includes a food elimination diet, proton pump inhibitors (such as Prilosec, Nexium or Protonix), swallowed steroids (fluticasone or viscous budesonide) and esophageal dilation.