Eosinophilic esophagitis historical perspective

In 1981, Picus and Frank reported a case of a 16-year-old boy with progressive dysphagia for 1.5 years, endoscopic findings were suggestive of multiple 1-mm nodular filling defects in the esophagus in an area of stricture with dilatation above. The radiology showed a luminal narrowing, wall rigidity, and high circulating eosinophil count assumed to be a variant of eosinophilic gastroenteritis.

• The historical perspective of the EoE is as the following:^{[1][2][3][4][5][6][7][8][9][10]}
• In 1978, Landres et al reported an isolated case of vigorous achalasia and concluded that this was a variant of eosinophilic gastroenteritis in a patient with marked hypertrophy and eosinophilic infiltration of esophagus.
• In 1981, Picus and Frank reported a case of a 16-year-old boy with progressive dysphagia for 1.5 years, endoscopic findings were suggestive of multiple 1-mm nodular filling defects in the esophagus in an area of stricture with dilatation above.
• The radiology showed a luminal narrowing, wall rigidity, and high circulating eosinophil count assumed to be a variant of eosinophilic gastroenteritis.
• In 1982, Münch et al and in 1983, Matzinger and Daneman both described isolated cases of esophageal eosinophilia with dysphagia in patients with assumed eosinophilic gastroenteritis.
• In 1985, Feczko et al reported 3 cases of eosinophilic infiltration of esophagus, with 2 of the patients showing eosinophilic gastroenteritis. Two out of the three patients developed esophageal stricture secondary to submucosal fibrosis.
• In 1985, eosinophilic infiltration was reported in esophageal mucosal biopsy of 11 patients with average age of 14.6 years. These patients had reflux symptoms and their eosinophil density was low. In retrospect, these were probably patients with gastroesophageal reflux disease (GERD).
• In 1989, Attwood et al described esophageal asthma, an episodic dysphagia with eosinophilic infiltrates.
• These investigators compared a group of 15 adults who presented with dysphagia without esophageal obstruction and normal pH monitoring to a group of 100 adults with GERD as defined by increased acid exposure in the distal esophagus.
• In 1993, Attwood et al reported 12 adults with dysphagia, normal pH monitoring, and dense esophageal eosinophilia. Seven patients had food hypersensitivity, and all required advanced intervention (dilatation and/or steroids in 1 case) for resolution of symptoms.
• In 1994, Straumann et al described a series of 10 patients with acute recurrent dysphagia seen over a 4-year period. These patients showed discrete endoscopic changes, and high concentrations of epithelial esophageal eosinophils. They improved following systemic steroid and antihistamine treatment.
• In 1995 the first publication in children was reported by Kelly et al. They identified 10 children who were diagnosed on clinical and histological grounds to have EoE.
• Six out of those ten had been subject to antireflux therapy without any symptomatic improvement. Two of these patients had already received fundoplication, and all responded well to amino acid formulas, suggesting an allergic etiology.
• The characteristics in pediatric EoE appeared to reflect greater amounts of regurgitation and failure to thrive, while the typical presentation in adults with EoE was dysphagia and food impaction.

• In 2003 the chronic nature of the natural history of EoE was described by Straumann et after the follow-up of 30 adults with EoE.

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