Idiopathic eosinophilic esophagitis is an inflammatory disease of the esophagus characterized by eosinophilia that can involve all the layers of the esophagus.
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Epidemiology
It is most commonly seen in males aged 20-40. It is an uncommon disease; however not rare.
Clinical presentation
Patients typically present with dysphagia or with food stuck in the esophagus. Usually, a specific food or allergen triggers the presentation, and symptoms may persist for a long time afterwards.
Pathology
The exact etiology is unknown. Exposure to food or allergen triggers the activation of eosinophils within the esophageal wall and a consequent inflammatory cascade ensues.
Esophageal strictures, webs and spasm cause the presentation of food impaction.
Radiographic features
Fluoroscopy
- 'ringed' esophagus: concentric, ring-like strictures of the esophagus on a barium swallow
- these ring-like strictures may co-exist with longer strictures and may be associated with esophageal spasm, dysmotility and foreshortening
CT
- non-specific esophageal submucosal edema
Treatment and prognosis
It is self-limiting in some cases but responds well to oral glucocorticoid therapy. It may lead to growth retardation in some children.
Differential diagnosis
- gastro-esophageal reflux, especially if the feline esophagus is present
- esophageal spasm
- intestinal parasitic infestation
- drug-induced esophagitis