Emerging insights into the presentation, pathophysiology, and management of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus with substantial clinical manifestations including dysphagia, odynophagia, food impaction and failure to thrive in children. New evidence is emerging regarding phenotypic and symptom variations in diverse EoE populations. EoE pathogenesis involves impaired epithelial barrier function, antigen-driven Type 2 inflammation, and eosinophilic infiltration, yet eosinophil and mast cell depletion does not improve patient symptoms. Recent research has unveiled new potential mechanisms of epithelial dysfunction, including the role of epithelial alarmins in inducing downstream inflammatory cascades. New clinical scoring tools are emerging to improve diagnosis and monitor disease severity. Therapeutic approaches for EoE are rapidly evolving with a wider range of therapies becoming available. Dietary elimination, topical corticosteroids, proton pump inhibitors (PPIs), and anti-type 2 biological agents aim to provide histologic and symptomatic relief. Overall, this review aims to present recent advances in the epidemiology, pathophysiology, diagnosis, and treatment of EoE, while also extending this information to the broader field of eosinophilic gastrointestinal diseases (EGIDs).