Читать книгу The Esophagus - Группа авторов - Страница 176

Eosinophilic esophagitis (EoE) has been recognized as an increasingly common inflammatory condition of the esophagus, occurring predominantly in young men with long‐standing dysphagia and recurrent food impactions, often associated with an atopic history, asthma, or peripheral eosinophilia [102]. The diagnosis of EoE can be confirmed on endoscopic biopsy specimens showing more than 20 eosinophils per high‐power field [102, 103]. The etiology is uncertain, but many authors believe that EoE develops as an inflammatory response to ingested food allergens in predisposed individuals [102, 103]. As a result, symptomatic patients often have a marked clinical response to treatment with steroids or elemental diets.

Figure 6.41 Peptic stricture. Double‐contrast view shows a smooth, tapered area of concentric narrowing (arrow) in the distal esophagus above a hiatal hernia.

Source: Reproduced from Gilchrist et al. [85], with permission.

The diagnosis of EoE may by suggested on barium studies by the presence of segmental esophageal strictures, sometimes associated with distinctive ring‐like indentations, producing a so‐called “ringed esophagus” [104] (Figure 6.53). The radiographic diagnosis may also be suggested by the development of a “small‐caliber esophagus” manifested by a long but variable‐length segment of narrowing in the thoracic esophagus that has smooth contours, tapered margins, and a mean diameter of 20 mm or less [105] (Figure 6.54), so 20 mm appears to be a useful threshold diameter for the diagnosis of EoE on barium studies.