Esophageal dilation in eosinophilic esophagitis

Solid-food dysphagia and food impaction are the hallmark symptoms of eosinophilic esophagitis (EoE) and are a result of subepithelial fibrosis, leading to esophageal stricture formation and loss of compliance of the esophagus. This fibrosis can be mechanically disrupted by esophageal dilation, which leads to a significant improvement in dysphagia in more than 80% of patients. The esophageal mucosa is quite fragile in patients with EoE, and dilation frequently leads to deep mucosal tears. The risk of esophageal perforation with dilation in EoE is likely increased over that seen with dilation in other benign esophageal diseases, but this risk has been overestimated in the earlier literature. Dilation in EoE, when done with some precaution, can be done relatively safely and in many cases of small-caliber esophagus, it needs to be done to alleviate symptoms. However, this dilation is frequently associated with postprocedure chest pain. In this article, we discuss the mechanisms of dysphagia in EoE to better understand the indications and timing of esophageal dilation in this disease. Then, we discuss the technique, efficacy, and importantly, the safety of esophageal dilation in EoE.