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Goldman 040204
Goldman 040204
Abdominal pain
Dysphagia
1
Spergel, JACI 2002, 109:363-368
Treatment
Food avoidance
Effective in children
Elemental formula reduced eosinophils and symptoms1
8/10 resolution, other 2 improved
Food avoidance based on all positive skin test and food
patch test:2
resolved symptoms in 18/24 kids w/ EE and improved
symptoms other 6. Milk, egg most common, but many others
implicated. Average of 3.6+/-2.1 foods
Mean esophageal eosinophils decreased 55.8/hpf8.4/hpf
No studies in adults
1
Kelly, Gastroenterology, 1995, 1503-1512
2
Spergel, JACI 2002, 109:363-
Treatment
Oral corticosteroids
Effective but side effects
Topical Steroids (swallowed “inhaled”
steroids)
Swallow FP 220 2pbid
Improvement in both adults and children
1
Teitlebaum, Gastroenterology 2002;122:1216
Treatment
Esophageal dilitation
Relieves obstruction, dysphagia often persists
PPIs for EE generally ineffective
EE vs. GERD
Characteristic EE GERD
Atopy High Nml
Food sensitization High Nml
Histology >24 eos/hpf 0-7 eos/hpf
Peripheral eosinophilia ~50% rare
Esophageal pH Normal Abnormal
PPI Usually not Helpful
helpful
Steroids Helpful Not helpful
Food allergen Sometimes Not helpful
elimination helpful