A 32-year-old woman with dysphagia for solid food presents to clinic for a follow-up visit. Upper endoscopy revealed multiple esophageal rings and eosinophilia but no strictures. The patient continues to complain of heartburn and food sticking. You recommend dilation with bougienage, a proton pump inhibitor (PPI), and corticosteroids as initial therapy.
Which of the following family histories is most consistent with the diagnosis of eosinophilic esophagitis (EOE) in this patient?
A. Mother with esophageal adenocarcinoma B. Father with gastric cancer C. Sister with gastroesophageal reflux disease (GERD) D. Multiple first-degree relatives with atopic disease
Multiple first-degree relatives with atopic disease-key concept/objective: to understand the presentation of eoe eoe has become an increasingly recognized cause of dysphagia and food impaction in young adults. endoscopy reveals findings of multiple esophageal rings. the etiology is unclear, but gerd, a congenital abnormality, and, possibly, allergic conditions have been implicated. eoe is characterized by esophageal eosinophilia of greater severity than found in acid reflux disease. the eosinophil density required for the diagnosis of eoe is greater than 15 eosinophils per high-power field in the mucosa; in addition, for a diagnosis to be made, the eosinophils must not clear after appropriate treatment with a ppi. eoe is often associated with other atopic diseases. patients may have a strong family history of atopy. although current studies have not established that gerd is a causal factor in eoe, there is clearly a role for acid suppression in those patients complaining of gerd symptoms. treatment consists of dilation with bougienage with or without acid suppression. in many cases, more than one treatment session is needed to achieve a desired esophageal lumen of 15 mm. these patients are at higher risk for painful, deep mucosal tears. pharmacologic treatment of eoe has been shown to result in improvement of clinical symptoms and histology in the majority of patients. therapeutic options include pharmacologic treatments, such as oral and topical corticosteroids, and leukotriene-receptor antagonists. dietary modification and elimination have been effective in the pediatric population, suggesting that certain foods may serve as environmental triggers for the eosinophilic infiltration. because many adults present with strictures, endoscopic esophageal dilation is another management modality. despite these treatment options, several controversies exist in the recommended treatment strategy. because little is known concerning the natural history of the condition, it is unclear whether the goal of therapy should be resolution of symptoms, resolution of tissue eosinophilia, or both.