Basic Pathogenesis of Eosinophilic Esophagitis

Blanchard, Carine; Rothenberg, Marc E.

doi:10.1016/j.giec.2007.09.016

Cited by 99 publications

(83 citation statements)

References 57 publications

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“…Fifty percent to seventy-five percent of patients with EoE are atopic, with a high prevalence of food-induced allergenspecific IgE [52] . This conclusion has been questioned after omalizumab an IgE antibody failed to improve the symptoms and reduce the eosinophilic infiltration in patients with EoE [53] .…”

Section: Genetic Vs Environmental Etiological Factorsmentioning

confidence: 99%

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Guarino

Cicala

Behar

2016

WJGPT

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Eosinophilic esophagitis (EoE) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus that may persist despite treatment with proton pump inhibitors. This eosinophilic infiltration is usually absent in the stomach, small intestine and colon, although there are a number of reports of patients with a multiorgan involvement. EoE is associated with abnormalities involving TH2-dependent immunity, with multiple environmental factors strongly contributing to disease expression. The layer of the esophagus affected by the eosinophilic infiltration causes the specific symptoms. Esophageal involvement results mostly in dysphagia for solids that can be severe enough to cause recurrent esophageal obstruction with typical endoscopic features suggesting esophageal remodeling and pathological changes of eosinophilic infiltration of the mucosa, sub-epithelial fibrosis and muscle hypertrophy. This disease is frequently associated with other allergic conditions such as allergic asthma, allergic dermatitis and eosinophilia. The treatment of patients with EoE depends on the severity of the symptoms and of the inflammatory process as well as to their response to a gradual step-up treatment. The first line of treatment consists of steroid containing local inhalers. If unresponsive they are then treated with oral steroids. Intravenous interleukin blockers seem to have a consistent positive therapeutic effect. Core tip: Eosinophilic esophagitis is a clinico-pathological entity characterized by esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus. Our manuscript provides a deep description of the disease showing that many efforts have been made in the last decades in understanding REVIEWSubmit a

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Section: Genetic Vs Environmental Etiological Factorsmentioning

confidence: 99%

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Guarino

Cicala

Behar

2016

WJGPT

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“…Dysphagia (difficulty swallowing) is a common problem affecting up to 22% of patients in primary care [189], and a characteristic feature of Alzheimer's, Parkinson's and ALS. Eosinophilic esophagitis (EE) is a newly recognized condition as of the mid 1990's [190]. It is characterized by eosinophil infiltration into the esophagus, which is manifested as dysphagia in adults and refractory reflux symptoms in children [191].…”

Section: Asthma Dermatitis and Eosinophilic Esophagitismentioning

confidence: 99%

Aluminum?s Role in CNS-immune System Interactions leading to Neurological Disorders

CA¹

2013

Immunome Res

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Multisystem interactions are well established in neurological disorders, in spite of conventional views that only the central nervous system (CNS) is impacted. We review evidence for mutual interactions between the immune and nervous systems and show how these seem to be implicated in the origin and progression of nervous system disorders. Well-established immune system triggers leading to autoimmune reactions are considered. Of these, aluminum, a known neurotoxicant, may be of particular importance. We have demonstrated elsewhere that aluminum has the potential to induce damage at a range of levels in the CNS leading to neuronal death, circuit malfunction and ultimately, system failure. Aluminum is widely used as an adjuvant in various vaccine formulations and has been implicated in a multisystem disorder termed "autoimmune/inflammatory syndrome induced by adjuvants" (ASIA). The implications of aluminum-induced ASIA in some disorders of the CNS are considered. We propose a unified theory capturing a progression from a local response to a systemic response initiated by disruption of water-based interfaces of exposed cells.

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“…The condition is not well understood, and several hypothesis have been proposed in its pathogenesis. 2 Eosinophilic esophagitis (EE) is an inflammatory disorder of the oesophagus characterized by eosinophilic infiltration of the oesophageal mucosa.…”

Section: Introductionmentioning

confidence: 99%

“…10 Physiologically, EoE is suspected to be an allergic response involving T-helper cell 2 mechanisms, with eosinophils degranulating and releasing various products that result in tissue damage, edema, inflammation and fibrosis. 11 The most widely followed treatment protocol is, swallowed topical corticosteroid therapy including fluticasone propionate and beclomethasone. 12 Because relapse rates are high, esophageal dilation has also been tried; however, it is associated with the potential risk of complications such as mucosal tears and perforations.…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic esophagitis: clinical features, endoscopic findings and response to treatment

et al. 2018

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Background: Eosinophilic esophagitis (EoE) considered to be an allergic inflammatory disorder of the esophagus characterised by an inherent impairment in epithelial barrier integrity, possibly worsened by reflux of gastric contents. The aim of this study was to study EoE and its clinical and endoscopic evaluation and response to treatment with relapse rates.Methods: Fifty patients in the study were selected based on a review of biopsy results from previous endoscopies performed between August 2015 to August 2017. All patients with biopsy-proven EoE, defined as more than 20 eosinophils/HPF. Biopsy samples were taken from the mid and distal esophagus and sent for analysis. The endoscopic findings were noted grossly. Twenty five patients were started on PPI’s only and the remaining 25 patients were started on fluticasone MDI 440mcg inhaled two times day and PPI. Follow up of the patients was done at 1, 3 and 6 months after treatment.Results: The mean age in the study population was 42 years, males affected more often (64%) with rings and corrugations and linear furrows being the most commonly seen endoscopic findings (64% and 27%). Normal study was seen in 40% of the patients. Most common symptom was dysphagia 26%. Steroids are the mainstay of the treatment along with PPI. Relapse rate was 61.1% in the study.Conclusions: EoE is an inflammatory condition of the oesophagus that occurs predominantly in young and middle-aged men, EE should be strongly considered in those who present with dysphagia and/or food impaction, particularly with a history of atopic disorders. Swallowed fluticasone is a safe and effective treatment; however, relapse rates are very high. In adults, there remains a need for a randomized controlled trial to assess the safety and efficacy of various treatment modalities.

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Basic Pathogenesis of Eosinophilic Esophagitis

Abstract: Eosinophilic esophagitis (EE) is a newly recognized disease, which has largely been called idiopathic EE, emphasizing the poor understanding of its pathogenesis.

Cited by 99 publications

References 57 publications

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Eosinophilic esophagitis: New insights in pathogenesis and therapy

Aluminum?s Role in CNS-immune System Interactions leading to Neurological Disorders

Eosinophilic esophagitis: clinical features, endoscopic findings and response to treatment

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