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Eosinophilic Esophagitis—A Primer for Otolaryngologists

Educational Objective
To discuss common presenting symptoms, work-up, and treatment of eosinophilic esophagitis for the general otolaryngologist.
1 Credit CME

Importance  Eosinophilic esophagitis (EoE) is a chronic, inflammatory condition of the esophagus. Prevalence of EoE is on the rise and, owing to its associated extragastrointestinal manifestations and comorbidities, otolaryngologists are increasingly encountering this condition in their practice.

Observations  Symptoms of EoE are vague and vary greatly based on patient’s age. The gastrointestinal symptoms include dysphagia, food impaction, feeding difficulties, symptoms mimicking gastroesophageal reflux, abdominal pain, vomiting, and failure to thrive. Several otolaryngologic symptoms are associated with EoE including rhinosinusitis, chronic cough, recurrent croup, hoarseness, and other aerodigestive symptoms refractory to gastroesophageal reflux therapy. Eosinophilic esophagitis is also frequently associated with other atopic conditions, such as asthma, eczema, and food allergies. The diagnosis is made on endoscopy with biopsies that reveal eosinophil-predominant esophageal inflammation. There are 3 major treatment approaches to EoE, commonly referred to as the 3 Ds: diet, drugs, and dilation. Untreated inflammation of esophagus from EoE can result in irreversible structural damage to the esophagus, leading to fibrosis, strictures, and impaired esophageal function.

Conclusions and Relevance  Eosinophilic esophagitis is now a fairly prevalent condition with considerable morbidity. Otolaryngologists should be familiar with the various clinical presentations of this condition in different age groups. Early diagnosis and treatment of this condition is a key for avoiding or postponing its complications.

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Article Information

Corresponding Author: Sandeep K. Gupta, MD, Pediatrics and Internal Medicine, University of Illinois College of Medicine at Peoria/Children's Hospital of Illinois, 530 NE Glen Oak Ave, North Bldg, Rm 6646, Peoria, IL 61637 (skgupta@uic.edu).

Accepted for Publication: December 5, 2018.

Published Online: February 21, 2019. doi:10.1001/jamaoto.2018.4177

Author Contributions: Dr Gupta had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: Gupta.

Drafting of the manuscript: Kumar, Gupta.

Critical revision of the manuscript for important intellectual content: All authors.

Administrative, technical, or material support: Kumar, Gupta.

Study supervision: Choi, Gupta.

Conflict of Interest Disclosures: Dr Gupta serves as consultant for Adare Pharmaceuticals Inc, Allakos, Abbott Laboratories, QOL Medical LLC and Receptos, Inc. He also receives research support from Shire Pharmaceuticals. No other conflicts are reported.

Funding/Support: Dr Gupta is supported in part by The Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) (U54 AI117804), which is a part of the Rare Diseases Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), National Center for Advancing Translational Sciences (NCATS), and is funded through collaborations between NCATS, National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Diabetes and Digestive and Kidney Diseases (NIDDKD).

Role of the Funder/Sponsor: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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