What is Eosinophilic esophagitis?

From the Guidelines

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus characterized by eosinophilic infiltration and symptoms such as dysphagia and food impaction.

Key Characteristics

• EoE is a food antigen-driven Th2 inflammatory condition that can occur in both children and adults 1
• It is estimated to affect 1 in every 2000 people and is more common in whites and males 1
• EoE is often associated with other atopic diseases, such as asthma, allergic rhinitis, and eczema 1

Diagnosis

• The diagnosis of EoE is based on symptoms, visual esophageal endoscopic findings, and histopathology 1
• Histopathology typically reveals eosinophils in the esophageal epithelium, with a threshold of ≥15 eosinophils per high-power field (eos/hpf) 1
• EoE can be distinguished from gastroesophageal reflux disease (GERD) by the failure of proton pump inhibitor (PPI) treatment to reduce esophageal eosinophilia 1

Management

• The most common management approaches for EoE include topical glucocorticosteroids, dietary elimination, and esophageal dilation 1
• PPIs are increasingly considered as a treatment rather than as a diagnostic test for EoE 1
• The goal of treatment is to achieve histologic remission of <15 eosinophils/high power field (eos/hpf) 1

From the Research

Definition and Characteristics of Eosinophilic Esophagitis

• Eosinophilic esophagitis (EoE) is a chronic antigen-mediated eosinophilic inflammatory disease isolated to the esophagus 2
• It is characterized by esophageal dysfunction and histologic findings of at least 15 eosinophils/high-powered microscope field (eos/hpf) 2
• EoE is a clinicopathologic disorder that requires a combination of clinical symptoms and histologic findings for diagnosis 2

Pathogenesis and Immune Response

• EoE is an immune-mediated esophageal disease with an influx of eosinophils to all layers of the esophagus, triggering an inflammatory response 3
• The disease is associated with an altered immune response, characterized by a combination of IgE-mediated and non-IgE-mediated mechanisms 4
• Food or environmental antigens stimulate a T-helper (Th)-2 inflammatory response, contributing to the pathogenesis of EoE 5

Clinical Features and Symptoms

• Common symptoms of EoE include food impaction, heartburn, and chest pain in adults 3
• Esophageal remodeling caused by chronic inflammation can lead to difficulties in swallowing 3
• EoE can be encountered in a substantial proportion of patients undergoing diagnostic upper endoscopy 6

Diagnosis and Diagnostic Guidelines

• Diagnosis of EoE requires at least 15 eosinophils visible per high-power field in biopsies obtained from different sites in the esophagus upon endoscopy with relevant esophageal symptoms 3
• Other diseases that can cause esophageal eosinophilia should be ruled out 3
• Consensus diagnostic guidelines have been established to aid in the diagnosis of EoE 5

Treatment Options

• Treatment options for EoE include pharmacologic therapy, dietary modification, and endoscopic dilation 5
• Topical corticosteroids, elimination diet, and proton pump inhibitors are commonly used treatments for EoE 6, 3
• New methods of management, including biological treatment, have recently emerged 3