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Best Pract Res Clin Gastroenterol. 2015 Oct;29(5):815-828. doi: 10.1016/j.bpg.2015.06.015. Epub 2015 Jul 8.

Esophageal dilation in eosinophilic esophagitis.

Author information

1
Hugh F. Culverhouse Chair for Esophageal Disorders, Division of Digestive Diseases & Nutrition, Joy McCann Culverhouse, Center for Esophageal and Swallowing Disorders, 12901 Bruce B. Downs Blvd., MDC 72, Tampa, FL 33612, USA. Electronic address: jrichte1@health.usf.edu.

Abstract

Tissue remodeling with scaring is common in adult EoE patients with long standing disease. This is the major factor contributing to their complaints of solid food dysphagia and recurrent food impactions. The best tests to define the degree of remodeling are barium esophagram, high resolution manometry and endoscopy. Many physicians are fearful to dilate EoE patients because of concerns about mucosal tears and perforations. However, multiple recent case series attest to the safety of esophageal dilation and its efficacy with many patients having symptom relief for an average of two years. This chapter will review the sordid history of esophageal dilation in EoE patients and outline how to perform this procedure safely. The key is graduated dilation over one to several sessions to a diameter of 15-18 mm. Postprocedural pain is to be expected and mucosal tears are a sign of successful dilation, not complications. In some healthy adults, occasional dilation may be preferred to regular use of medications or restricted diets. This approach is now supported by recent EoE consensus statements and societal guidelines.

KEYWORDS:

Eosinophilic esophagitis; Esophageal dilation; Esophageal perforation; Esophageal remodeling; Esophageal stricture

PMID:
26552780
DOI:
10.1016/j.bpg.2015.06.015
[Indexed for MEDLINE]

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