Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults

Abstract

In the absence of secondary causes, eosinophilic esophagitis (EoE) is a chronic, local, progressive, T-helper type 2 immune-mediated disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In the last 20 years, the incidence and prevalence of EoE have risen sharply, and the chances of encountering affected patients in clinics and endoscopy rooms have increased. Nevertheless, it is estimated that the mean diagnostic delay of EoE is 4–6 years in both children and adults. Unfortunately, the longer the disease stays unrecognized, the likelier it is for the patient to have persistent or increased esophageal eosinophilic inflammation, to complain of non-resolving symptoms, and to develop fibrotic complications. Early detection depends on the recognition of initial clinical manifestations that vary from childhood to adulthood and even among patients of the same age. The disease phenotype also influences therapeutic approaches that include drugs, dietary interventions, and esophageal dilation. We have herein reviewed epidemiologic, clinical, endoscopic, and histologic features and therapeutic options of EoE focusing on differences and similarities between children and adults that may certainly serve in daily clinical practice.

Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach

“…Eosinophilic esophagitis (EoE) is a unique form of non-immunoglobulin E (IgE)-mediated food allergy, restricted to the esophagus, characterized by esophageal eosinophil-predominant inflammation and dysfunction [ 1 , 2 , 3 ]. It currently represents the most common eosinophilic gastrointestinal disorder as well as the most common cause of dysphagia and food impaction among children and young adults [ 4 ].…”

“…However, EoE prevalence estimates vary with location. A significant increase in prevalence has recently been described in Europe and North America, where EoE now affects more than 1 in every 1000 people, including both children and adults [ 3 , 5 ]. In contrast, lower prevalence estimates have been reported in Japan and China, where EoE is diagnosed in 20 of every 100,000 esophago-gastroduodenoscopies (EGDS) [ 6 ].…”

“…The natural history of EoE is believed to be a progression [ 8 ], and clinical presentation varies with age and disease duration. Adults commonly present with dysphagia and bolus impaction, whereas children usually have reflux-like and non-specific upper gastrointestinal symptoms [ 3 ]. Esophageal chronic inflammation causes strictures, thickening, luminal narrowing, furrowing, transient and fixed rings formation [ 15 ], and is associated with esophageal dysmotility [ 16 , 17 , 18 , 19 ].…”

“…Therapeutic strategies comprise dietary regimens, proton pump inhibitors (PPIs), topical corticosteroids, biologic agents acting on molecular pathways of the inflammatory cascade, and esophageal dilation when strictures are present [ 3 , 21 , 22 , 23 ].…”

“…EoE virtually requires a lifelong therapy as it invariably relapses when treatment is withdrawn [ 3 ]. Avoidance of trigger food(s) offers a unique long-term, drug-free alternative for the management of the disease.…”