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WAO Journal Issue Review

Posted: November 2008

Eosinophilic Esophagitis
Gastrointestinal Endoscopy Clinics of North America
Volume 18, Issue 1, Pages 1-224 (January 2008)
Guest Editor: Furuta, G.T.
Consulting Editor: Lightdale, C.D.
ISSN: 1052-5157

Available from: Saunders/Elsevier

Alyson Kakakios MB BS, FRACP
Department of Allergy and Immunology
The Children's Hospital at Westmead
Westmead, Sydney, New South Wales

This issue of "Gastrointestinal Endoscopy Clinics of North America" is very timely since it marks the transition of eosinophilic esophagitis (EE) from an emerging disease to an established disorder whose importance has led to two international conferences and the publication of consensus recommendations for diagnosis and treatment (Gastroenterology 2007; 133:1342-1363). This state-of-the-art issue on eosinophilic esophagitis makes several things clear:

  • Eosinophilic esophagitis is a complex disorder with a truly multidisciplinary nature involving gastroenterologists, adult and paediatric specialist physicians, pathologists, allergists, surgeons, dietitians and scientists.
  • EE is an important disease which causes considerable morbidity in those affected.
  • EE is a chronic disease with few patients "outgrowing" their illness, indeed, EE may be the paradigm for a disease that begins in childhood and extends into adult life.
  • EE is increasing in incidence and prevalence with approximately a three-fold increase in incidence over the past two decades.
  • Although there is still much to be learned about many aspects of EE this issue on EE goes a long way towards an understanding of the natural history, pathogenesis, biomarkers and therapeutic approaches which will be of great importance in developing new diagnostic tools and therapeutic options for this disease.

The purpose of this issue is to provide the latest update on EE. This has been achieved by assembling an extraordinary group of authors of individual chapters each of whom brings to the topic their unique perspectives of the disease arising from their particular area of specialization and research.

The issue is targeted not only at gastroenterologists performing endoscopies, although this is clearly a major audience, but also at paediatricians, allergists and pathologists. As a reviewer who is a paediatric immunologist actively involved in treating infants, children and adolescents with this disorder, my hope is that the issue will reach a much wider audience than might usually be the case with this series.

As usual with the "Clinics of North America" format, each of the chapters is contributed by one or two authors from the viewpoint of their particular interest in the disorder, whether that be clinical, pathology, pathogenesis, treatment, diagnosis, paediatric or adult, allergy or gastroenterology. Given the nature of this "bringing together of the experts" there is considerable repetition of facts and information but there are also unique contributions derived from each of the authors' individual expertise.

Given that this is the "Gastrointestinal Endoscopy Clinics" it is not surprising that there are some beautiful pictures of the superficial appearance of the oesophagus in this disorder. This is of great importance for the non-gastroenterologist to be able to visualize the changes to the oesophagus, such as the linear furrowing, exudate, stenotic rings and strictures and to relate these to the clinical picture. For example, on page 55 there is a particularly interesting endoscopic view of meat impacted in the distal oesophagus of a previously asymptomatic adolescent boy which clearly shows the linear furrowing and exudate consistent with EE. Also of particular interest were the chapters relating to basic pathogenesis, ENT manifestations (new to me) and the possible relationship of oesophageal dysmotility syndromes (including achalasia) to EE. The importance of taking biopsies (5 from different places in the oesophagus) and of reviewing these biopsies with the pathologists is emphasized. The final chapter provides an integrated approach to treatment of children and adults with eosinophilic esophagitis. In this article, a paediatric gastroenterologist, an adult gastroenterologist and a paediatric allergist combine their efforts to provide a clear, practical approach to the evaluation and treatment of patients with EE.

This issue of Gastrointestinal Endoscopy Clinics of North America brings together experts in the field of Eosinophilic Esophagitis in a way which to my knowledge has not been done before for this entity and which provides a state-of-the-art summary of all the major areas of the disorder. As expected for "the Clinics" it is very oriented towards North America with only one author, Alex Straumann, from outside the USA. However, each chapter is well-referenced and interestingly enough the Guest Editor Glenn Furuta, an acknowledged expert in EE himself, states that "the English language-centric medical community could have been light years ahead in its identification of this disease if it had recognized one of the first descriptions published by a private practice gastroenterologist from Olten County, Switzerland (Alex Straumann) in 1994." My own perspective as a Paediatric Immunologist working in a large public children's hospital, is one of considerable respect mixed with a degree of envy for the way in which our North American colleagues have embraced the idea of a multidisciplinary approach to this complex, fascinating, important and increasingly common disease and I can only hope that this particular issue is read with as much interest worldwide, particularly in Australia, as it truly deserves. I think this is a "must-have" for all clinicians involved with diagnosing, treating and understanding this disorder.