Environmental and infectious factors in eosinophilic esophagitis

Abstract

Identifying possible environmental or infectious etiologic factors for eosinophilic esophagitis (EoE) may offer insight into opportunities for disease prevention and treatment. We reviewed the current literature to assess environmental and infectious factors evaluated in EoE. Few studies have been conducted, however a consistent inverse association between EoE and H. pylori has been described. Several studies suggest a weak association between season and EoE diagnosis, but the evidence is inconclusive. EoE has also been associated with early life factors, including Cesarean delivery and antibiotic use. Larger studies are needed to evaluate these associations more thoroughly. Several papers have speculated the potential for anti-secretory agents to contribute to EoE. This has not been formerly evaluated. In summary, there is significant opportunity in the future to advance our understanding of possible environmental etiologic factors for EoE.

Genetics of eosinophilic esophagitis

“…The EoE-risk loci contain genes with known roles in the pathoetiology of EoE (Figure 3); careful mechanistic studies are important because they will reveal specific molecular pathways that increase disease risk in patients with EoE. Given the important role of early life exposure events as EoE-risk factors, 111 a deeper analysis of the microbiome and its interaction with EoE-risk variants is likely to be informative.…”

Eosinophilic Esophagitis: A Comprehensive Review

“…As Jensen and Dellon point out in their review article the common link between these components may be that these entities may interfere with oral and immune tolerance, the process by which the human body interacts with the millions of potentially antigenic particles in the environment [34]. A recent study showing the esophageal microbiome in EoE patient to be different than that of controls may further this notion [35].…”

Lymphocytic oesophagitis, eosinophilic oesophagitis and compound lymphocytic–eosinophilic oesophagitis I: histological and immunohistochemical findings

“…Unexpectedly, the number of cases now referred to as eosinophilic oesophagitis (EoE) has dramatically increased in later years,2 reaching epidemic proportions 3. Recent population-based data showed that the estimated EoE prevalence in the USA is 56.7 per 100 000 persons 4 5. The histological diagnosis is based on the presence of ≥15 eosinophils/high power field (HPF) in H&E stained sections from the oesophageal squamous epithelium 6.…”