Physicians need to think of eosinophilic esophagitis (EE) as a possible diagnosis if patients say they have difficulty swallowing, have had food caught in their esophagus or are experiencing little, if any, relief for heartburn despite taking proton pump inhibitors or other medications, said Chris A. Liacouras, professor of pediatrics at the University of Pennsylvania School of Medicine and the Children's Hospital of Philadelphia. The foods most likely to cause problems include milk, soy, eggs, wheat, nuts and fish.
While gastroesophageal reflux disease (GERD) is a relatively common disease, most often characterised by frequent heartburn, EE is much less common. Estimates suggest one to four cases of the disease for every 10,000 children and adults, said Dr Glenn Furuta director of the Gastrointestinal Eosinophil Diseases Program at the University of Colorado School of Medicine in Denver.
And that number appears to be increasing, said Marc Rothenberg, director of the Cincinnati Center for Eosinophilic Disorders at Cincinnati Children's Hospital Medical Centre. 'The first patient with EE recognised at our hospital was in 1999. Now we are seeing three to five new cases per week and 30 follow-up visits per week.'
Dr. Liacouras believes this increase is due to greater recognition of the disease as well as its being caused by an allergy. Allergies have been proliferating in recent years.
The recognition of EE also has evolved with the development of endoscopy in the 1960s and 1970s since the procedure is required for diagnosis, said Dr Furuta. The disease was recognised among children sooner than it was among adults because "pediatric gastroenterologists routinely obtain esophageal biopsies, whereas adult gastroenterologists have not followed this same practice."
Although EE doesn't seem to be life-threatening, it can impact quality of life and thus steroids are often used to decrease the inflammation. But, since the disease is chronic, repeated doses of steroids are necessary.
The elimination of the suspect foods is the alterantive treatment path but, sicne they may be many and v arious, it isn't easy to follow.
