From the Guidelines
Eosinophilic esophagitis (EoE) is primarily caused by an allergic immune response to food allergens or environmental allergens that triggers inflammation in the esophagus, with genetic factors and acid reflux also playing a significant role in its development. The most common food triggers include dairy products, wheat, eggs, soy, nuts, and seafood, while environmental allergens such as pollen, dust mites, and animal dander can also contribute to EoE development 1. Genetic factors play a significant role, as EoE tends to run in families, particularly those with a history of allergic conditions like asthma, eczema, or allergic rhinitis, with specific gene variants affecting esophageal barrier function and immune regulation 1. Additionally, acid reflux may contribute to EoE by damaging the esophageal lining, making it more susceptible to allergen penetration and immune activation 1. The immune response in EoE involves T-helper type 2 (Th2) cells releasing cytokines that attract eosinophils to the esophagus, causing inflammation, tissue damage, and eventually fibrosis and strictures if left untreated 1.
Some key points to consider in the causes of EoE include:
- The role of food allergens and environmental allergens in triggering the allergic immune response
- The significance of genetic factors, including specific gene variants that affect esophageal barrier function and immune regulation
- The potential contribution of acid reflux to EoE development
- The importance of T-helper type 2 (Th2) cells and eosinophils in the immune response
- The need for further research into the causes and management of EoE, including the development of symptom severity questionnaires and decision tools to aid initial therapy 1.
Overall, the causes of EoE are complex and multifactorial, and further research is needed to fully understand the underlying mechanisms and to develop effective management strategies.
From the Research
Causes of Eosinophilic Esophagitis
The causes of eosinophilic esophagitis (EE) are complex and multifactorial. Some of the key factors that contribute to the development of EE include:
- Food allergies: Studies have shown that food allergies play a significant role in the development of EE 2, 3, 4. Common food allergens that trigger EE include dairy, eggs, wheat, soy, and nuts.
- Aeroallergens: Aeroallergens, such as pollen and dust mites, have also been implicated in the development of EE 2, 3.
- Genetic predisposition: Individuals with a family history of atopy or other allergic diseases are more likely to develop EE 2, 5.
- Environmental factors: Environmental factors, such as exposure to pollution and changes in diet, may also contribute to the development of EE 5.
- Immunological responses: EE is characterized by a non-IgE-mediated food hypersensitivity, which involves a complex interplay of immune cells and cytokines 3, 4.
Pathophysiology of Eosinophilic Esophagitis
The pathophysiology of EE involves a range of immune and inflammatory responses, including:
- Eosinophilic inflammation: Eosinophils play a key role in the development of EE, and their presence in the esophagus is a hallmark of the disease 2, 3.
- Cytokine production: Cytokines, such as interleukin 5, play a crucial role in the recruitment and activation of eosinophils in the esophagus 2.
- Epithelial barrier defects: Defects in the epithelial barrier of the esophagus may contribute to the development of EE by allowing allergens to penetrate the mucosa and trigger an immune response 3, 4.
Triggers of Eosinophilic Esophagitis
Triggers of EE include: