But the disease may be more common than is known clinically. A study in which 1000 random people in northern Sweden were studied endoscopically led researchers to conclude that 1.1% of the population in that country have more than 20 eosinophils per high-power field.
Explore This IssueAugust 2009
Esophageal eosinophilia may be much more common, and many of these people may be totally asymptomatic or minimally symptomatic, Dr. Alexander said.
Endoscopic findings that might signal eosinophilic esophagitis include rings, stricture, furrow or straight lines, white spots, and a small-caliber esophagus, he said. But in 30% of patients, endoscopic exams turned up normal.
Although food allergens and allergens in the air are suspected of triggering the production of eosinophils that lead to the disease’s inflammation, the cause isn’t known for sure.
Michael J. Rutter, MD, Associate Professor of Otolaryngology at the University of Cincinnati College of Medicine, laid out the benefits of early diagnosis of the disease, particularly in children with severe subglottic stenosis requiring laryngotracheal reconstructive surgery. In this population, if airway reconsructive surgery is attempted, when the patient actually has eosinophilic esophagitis, the odds of success are greatly diminished.
A 2003 study by Johnson et al in Transactions of the ABEA described the cases of 12 children suffering from subglottic stenosis who eventually were diagnosed with eosinophilic esophagitis with more than 24 eosinophils per high-power field.
In six of the children, 19 airway reconstruction attempts were made but failed before the eosinophilic esophagitis was diagnosed. The other six were diagnosed with the disease before reconstruction was attempted, Dr. Rutter said.
Researchers concluded that there was an 80% failure rate when patients had undiagnosed and untreated eosinophilic esophagitis, and an 80% success rate when the disease was discovered and properly managed.
He described a typical case: A six-year-old boy who was referred to him had been born prematurely, had had a patent ductus arteriosus ligation, and had been diagnosed with bronchopulmonary dysplasia.
He had left vocal cord paralysis and grade 3 subglottic stenosis, and single-stage laryngotracheal reconstruction surgery had failed at age three. There were no symptoms that suggested aspiration, reflux, dysphagia, or allergies-nothing that openly suggested eosinophilic esophagitis.
On the initial evaluation, it was observed on flex bronchoscopy that H. flu had colonized. Finally, an esophagogastroduodenoscopy (EGD) found nearly all the visual signs of the disease, including furrows and white patches. He was found to have 109 eosinophils per high-power field.