Eosinophilic Esophagitis in the Aerodigestive Patient: Diagnosis and Treatment

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus with varied presentations including gastrointestinal and airway symptoms that are frequently seen in aerodigestive patients. Common gastrointestinal manifestations in older children or adults include solid food dysphagia and food impaction, while feeding dysfunction or vomiting is more common in younger children. Airway symptoms are diverse and include chronic cough, wheezing, rhinosinusitis, and croup. While symptoms can suggest a diagnosis of EoE, endoscopy with biopsy is required for definitive diagnosis. Treatment goals include controlling symptoms and preventing long-term progression to fibrostenotic disease. Primary treatment options currently include dietary modifications, swallowed steroids, or acid suppression, though a variety of biologic medications are being studied, including dupilumab which recently became the first FDA-approved EoE treatment option. EoE is a chronic condition and studies show progression to fibrostenotic disease in a majority of patients not receiving treatment. This chapter discusses the presentation, diagnosis, and treatment of EoE, with a particular focus on EoE in the aerodigestive patient population.