Chapter 26: Eosinophilic esophagitis

Area of Science:

• Gastroenterology
• Allergy Immunology
• Pathology

Background:

• Eosinophilic esophagitis (EoE) is an allergic inflammatory disease characterized by esophageal eosinophilia.
• It is differentiated from gastroesophageal reflux disease (GERD) by persistent eosinophil presence despite proton-pump inhibitor therapy.
• EoE presents with varied symptoms across age groups, including feeding disorders in young children and dysphagia or food impaction in older children and adults.

Purpose of the Study:

• To summarize the key diagnostic features and current management strategies for Eosinophilic Esophagitis (EoE).
• To highlight the differences between EoE and GERD.
• To discuss the role of diet and pharmacotherapy in EoE treatment.

Main Methods:

• Review of clinical presentation, endoscopic findings, and histological criteria for EoE diagnosis.
• Discussion of molecular mechanisms including mast cell activation, IL-5, and eotaxin-3.
• Evaluation of treatment efficacy for dietary interventions and topical corticosteroids.

Main Results:

• EoE diagnosis relies on persistent esophageal eosinophilia (≥15 eosinophils/high-power field) and specific endoscopic findings like linear furrows and white plaques.
• Molecular studies show increased IL-5 and eotaxin-3 expression in EoE mucosa.
• Dietary therapy (elemental/amino acid-based formula) is effective in children, while topical corticosteroids are the established pharmacotherapy for improving symptoms and eosinophilia.

Conclusions:

• Eosinophilic esophagitis (EoE) is a distinct allergic condition diagnosed by esophageal eosinophilia and specific clinical/histological findings.
• While dietary changes can be effective, particularly in children, topical corticosteroids represent the current gold standard for managing EoE.
• Understanding the pathophysiology and diagnostic markers is crucial for effective management of this growing condition.