History and exam

Key diagnostic factors

common

dysphagia

Hallmark feature in adolescents and adults and is often a long-standing symptom.[1][2][28]​​

Severity can range from food going down slowly, to transiently sticking, to sticking for a longer period of time requiring regurgitation, to frank food bolus impaction requiring urgent endoscopy to clear the bolus.​[4][13]​​[14][15]​​​

food avoidance and modification behaviors

Many patients have coped with symptoms for years, have modified their eating to chew thoroughly, eat slowly, drink copious liquids, lubricate foods, or avoid foods that tend to get stuck. They may also not go out to eat for fear of having an episode of food sticking in public.

Avoidance and modification behaviors minimize symptoms, and should be asked about specifically.

Other diagnostic factors

common

heartburn

Older children, adolescents, and adults may report heartburn.[1][2][3]

chest discomfort

Older children, adolescents, and adults may report chest discomfort.[1][2][3]

nausea/vomiting

Nonspecific symptom, more common in infants and children.[1][2][3]

regurgitation

Nonspecific symptom, more common in infants and children.[1][2][3]

abdominal pain

Nonspecific symptom, more commonly reported in children.[1][2][3]

failure to thrive

Nonspecific symptom in infants.[1][2][3]

irritability

Nonspecific symptom in infants. Crying and feed intolerance may also be reported.[1][2][3]

Risk factors

strong

family history of EoE

In patients who have a parent or sibling with EoE, there is an approximately 3% risk of developing the condition.[77]​ This is significantly higher than the general population, where the mean estimate of prevalence is 63 per 100,000 people (0.063%).[16]

Concordance with dizygotic twins is approximately 20%, and with monozygotic twins, approximately 40%. Overall heritability has been estimated to be 14.5%.​[77]

male sex

Approximately two-thirds of patients are male, although the reasons for this are unknown.[27][28]​​

atopic disease

Up to 80% of children and 60% of adults have been reported to have concomitant allergic conditions (e.g., asthma, atopic dermatitis, allergic rhinitis/sinusitis, or food allergies).[31][32][33][34][35]​​[36]

children and younger adults

The condition has been reported in patients of all ages, but is more commonly seen in children and younger adults, with the peak prevalence occurring between ages 30 years and 40 years.[26]​​

white ancestry

While the condition is more common in white people compared with nonwhite people, it has been reported in multiple ethnic and racial populations.[29][30]

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