From the Guidelines
Eosinophilic Esophagitis (EOE) is a chronic, immune-mediated condition characterized by eosinophil infiltration of the esophagus, leading to inflammation and symptoms such as dysphagia, food impaction, and chest pain, often triggered by food allergens. Patients with EOE typically experience difficulty swallowing, food impaction, chest pain, heartburn, and in children, feeding difficulties or failure to thrive 1. The condition is often triggered by food allergens, with common culprits including dairy, wheat, eggs, soy, nuts, and seafood. Diagnosis requires an endoscopy with biopsies showing ≥15 eosinophils per high-power field.
Key Characteristics of EOE
- Chronic immune-mediated condition
- Eosinophil infiltration of the esophagus
- Inflammation and related symptoms
- Often triggered by food allergens
- Diagnosis requires endoscopy with biopsies
Treatment Approaches
- Dietary modifications (elimination diets)
- Medications (primarily topical steroids like fluticasone or budesonide)
- Endoscopic dilation for strictures
- Proton pump inhibitors like omeprazole may help some patients The condition is increasingly recognized, affecting about 1 in 2,000 people, and requires ongoing management as it tends to be chronic 1. Without treatment, EOE can lead to esophageal narrowing, making eating progressively more difficult and potentially dangerous. The most effective treatment approach often involves a combination of these methods, with swallowed topical glucocorticosteroids receiving a strong recommendation, and conditional recommendations for PPI and diet therapy as well as esophageal dilation 1.
From the Research
Definition and Characteristics of Eosinophilic Esophagitis (EOE)
- Eosinophilic esophagitis (EoE) is a chronic and abnormal Th2 type immunological response characterized by intense eosinophilic inflammation localized within the esophagus 2.
- This condition leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis 2.
- EoE is an inflammatory disease of the esophagus triggered by foods and possibly environmental allergens 3.
Diagnosis and Differentiation
- EoE should be differentiated from secondary esophageal eosinophilia (EE) in gastroesophageal reflux disease (GERD) and eosinophilic gastroenteritis, involving the entire gastrointestinal tract 2.
- A trial of proton pump inhibitor (PPI) therapy is a mandatory diagnostic first step, given that at least one third of patients with suspected EoE will have PPI-responsive esophageal eosinophilia 4.
- Typical EoE does not respond to proton pump inhibitor (PPI) therapy according to the current Western diagnostic guidelines 2.
Treatment Options
- Established anti-inflammatory treatments for EoE include dietary therapy, proton pump inhibitors, and swallowed topical steroids, which should be combined with endoscopic dilation in case of strictures 5.
- Topical corticosteroids to the esophagus are being used, and PPIs should be considered another treatment for EoE and not a diagnostic tool 6.
- Maintenance anti-inflammatory therapy is necessary to prevent esophageal fibrotic remodeling and stricture formation 4.