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EoE behaves as a unique Th2 disease: a narrative review.
Simon S Rabinowitz1, Liwei Yu1, Patrick Geraghty2,3
1Division of Pediatric Gastroenterology, Children's Hospital at Downstate, Downstate Health Sciences University, Brooklyn, NY, USA.
Translational Gastroenterology and Hepatology
|January 27, 2023
Summary
Eosinophilic esophagitis (EoE) lacks serologic markers and does not respond to biological therapies, unlike asthma, atopic dermatitis, and chronic rhinosinusitis. This suggests a unique Th2 pathway mechanism in EoE.
Area of Science:
- Immunology
- Gastroenterology
- Allergy
Background:
- Eosinophilic esophagitis (EoE) is a type 2 helper cell (Th2) mediated disease.
- EoE shares inflammatory pathways with asthma, atopic dermatitis (AD), and chronic rhinosinusitis (CRS).
- Distinct characteristics of EoE suggest a unique pathophysiologic mechanism.
Purpose of the Study:
- To compare serologic markers and response to biological therapies in EoE versus other Th2 diseases.
- To highlight key differences in EoE's Th2 pathway activation and therapeutic response.
- To propose and summarize evidence for a novel EoE pathophysiology.
Main Methods:
- Conducted four narrative reviews combining PubMed and Google searches.
- Reviewed studies on serologic markers in EoE compared to asthma, AD, and CRS.
- Compared responses to parenteral biological therapies in EoE and other Th2 diseases.
Main Results:
- EoE lacks identifiable serologic markers, unlike asthma, AD, and CRS.
- EoE does not respond to parenteral biological therapies, whereas other Th2 diseases show significant therapeutic benefit.
- Literature supports a novel pathophysiology for EoE.
Conclusions:
- EoE's unique presentation may stem from a distinct application of the Th2 pathway.
- A potential mechanism involves exclusive activation of the Th2 cascade by esophageal mucosal constituents.
- This localized pathway activation may lead to fibrostenotic changes characteristic of EoE.
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