Esophageal strictures in adult eosinophilic esophagitis: dilation is an effective and safe alternative after failure of topical corticosteroids

Strictures are a frequent complication of eosinophilic esophagitis. The efficacy and safety of topical corticosteroids and of dilation of eosinophilic esophagitis-associated strictures have not yet been thoroughly clarified. We present a retrospective analysis of 10 adult patients with eosinophilic esophagitis who had symptomatic esophageal stenosis that was unresponsive to topical corticosteroids, and who were treated using bougienage. Eight patients had one single stricture, one patient had two, and another had three strictures; mean stricture length was 2.1 cm (range 1 - 6 cm). Bougienage led to prompt symptom relief. Apart from transient postprocedural odynophagia, no severe complications occurred. During the follow-up (mean 6 months; range 2 - 11 months), all patients enjoyed sustained treatment response.

References

• 1 Walsh S V, Antonioli D A, Goldman H. et al . Allergic esophagitis in children: a clinicopathological entity.  Am J Surg Pathol. 1999;  23 390-396
• 2 Desai T K, Stecevic V, Chang C H. et al . Association of eosinophilic inflammation with esophageal food impaction in adults.  Gastrointest Endosc. 2005;  61 795-801
• 3 Orenstein S R, Shalaby T M, di Lorenzo C. et al . The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children.  Am J Gastroenterol. 2000;  95 1422-1430
• 4 Langdon D E. ”Congenital“ esophageal stenosis, corrugated ringed esophagus, and eosinophilic esophagitis.  Am J Gastroenterol. 2000;  95 2123-2124
• 5 Straumann A, Spichtin H P, Grize L. et al . Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years.  Gastroenterology. 2003;  125 1660-1669
• 6 Kaplan M, Mutlu E A, Jakate S. et al . Endoscopy in eosinophilic esophagitis: ”feline“ esophagus and perforation risk.  Clin Gastroenterol Hepatol. 2003;  1 433-437
• 7 Eisenbach C, Merle U, Schirmacher P. et al . Perforation of the esophagus after dilation treatment for dysphagia in a patient with eosinophilic esophagitis.  Endoscopy. 2006;  38 E43-E44
• 8 Vakil N, Morris A I, Marcon N. et al . A prospective, randomized, controlled trial of covered expandable metal stents in the palliation of malignant esophageal obstruction at the gastroesophageal junction.  Am J Gastroenterol. 2001;  96 1791-1796
• 9 Croese J, Fairley S K, Masson J W. et al . Clinical and endoscopic features of eosinophilic esophagitis in adults.  Gastrointest Endosc. 2003;  58 516-522
• 10 Straumann A, Rossi L, Simon H U. et al . Fragility of the esophageal mucosa: a pathognomonic endoscopic sign of primary eosinophilic esophagitis?.  Gastrointest Endosc. 2003;  57 407-412
• 11 Teitelbaum J E, Fox V L, Twarog F J. et al . Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate.  Gastroenterology. 2002;  122 1216-1225
• 12 Remedios M, Campbell C, Jones D M. et al . Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate.  Gastrointest Endosc. 2006;  63 3-12
• 13 Arora A S, Perrault J, Smyrk T C. Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults.  Mayo Clin Proc. 2003;  78 830-835