Eosinophilic Esophagitis

Abstract

ImportanceEosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus that affects an estimated 34.4/100 000 people in Europe and North America. EoE affects both children and adults, and causes dysphagia, food impaction of the esophagus, and esophageal strictures.ObservationsEoE is defined by symptoms of esophageal dysfunction, such as vomiting, dysphagia, or feeding difficulties, in a patient with an esophageal biopsy demonstrating at least 15 eosinophils per high-power field in the absence of other conditions associated with esophageal eosinophilia such as gastroesophageal reflux disease or achalasia. Genetic factors and environmental factors, such as exposure to antibiotics early in life, are associated with EoE. Current therapies include proton pump inhibitors; topical steroid preparations, such as fluticasone and budesonide; dietary therapy with amino acid formula or empirical food elimination; and endoscopic dilation. In a systematic review of observational studies that included 1051 patients with EoE, proton pump inhibitor therapy was associated with a histologic response, defined as less than 15 eosinophils per high-power field on endoscopic biopsy, in 41.7% of patients, while placebo was associated with a 13.3% response rate. In a systematic review of 8 randomized trials of 437 patients with EoE, topical corticosteroid treatment was associated with histologic remission in 64.9% of patients compared with 13.3% for placebo. Patients with esophageal narrowing may require dilation. Objective assessment of therapeutic response typically requires endoscopy with biopsy.Conclusions and RelevanceEoE has a prevalence of approximately 34.4/100 000 worldwide. Treatments consist of proton pump inhibitors, topical steroids, elemental diet, and empirical food elimination, with esophageal dilation reserved for patients with symptomatic esophageal narrowing.

CD73+ Epithelial Progenitor Cells That Contribute to Homeostasis and Renewal Are Depleted in Eosinophilic Esophagitis

“…Damage to the epithelium from the inflammation in EoE drives symptomatology, as well as progression of esophageal fibrostenosis, 2 , 11 , 26 leading to food impactions and stricture. Moreover, PPI, steroids, or diet modification are the only treatment options currently available to EoE patients.…”

“…EoE is an allergen-induced chronic inflammatory disease of the esophagus, characterized by dysphagia, food impactions, and fibrotic strictures. 2 Histologically, the most conspicuous finding in EoE, in addition to the eosinophilic infiltrate, is basal cell hyperplasia (BCH). 3 , 4 BCH is induced by injury or inflammation and involves an expansion of basal cells (>20% of epithelial height) with limited formation of intercellular bridges, a hallmark of squamous cell differentiation.…”

Exploring Treatment Options for Eosinophilic Esophagitis

“…Regardless of age, an edematous and inflammatory appearance of the esophagus can indicate underlying EoE. The pathologic criteria for the diagnosis of EoE is the presence of 15 or more eosinophils per high power field on histologic exam of biopsy specimens [2,6]. Of note, it is pertinent to perform a workup for other causes of dysphagia, such as GERD and achalasia, to rule out additional disease processes [2].…”

“…The current literature has recognized the highest prevalence of the condition in middle-aged Caucasian males; however, a diagnosis of EoE should be considered in any patient presenting with symptoms of dysphagia, regardless of age, race, or sex. In addition to dysphagia, patients with EoE also typically present with symptoms of food impaction, heart burn, regurgitation, vomiting, and chest pain [2,3]. Interestingly, adults and children may have different manifestations of the disease.…”

“…Similarly, several genes are currently being studied in association with EoE, such as Chemokine ligand 26 (CCL26), Calpain 14 (CAPN14), Thymic stromal lymphopoietin (TSLP), Signal Transducer and Activator of Transcription 6 (STAT6), and Leucine Rich Repeat Containing 32 (LRRC32), in hopes that this could further inform future treatment options. Additionally, recent research has shown the association of EoE with environmental risk factors, such as cesarean birth, formula feeding, certain antibiotic use, cold climates, and Helicobacter pylori colonization; the influence of the esophageal microbiota has also been researched, but its role remains unclear [2,4]. Importantly, EoE develops due to a combination of tissue remodeling, loss of barrier defenses, and eosinophilic inflammation.…”