Eosinophilic Esophagitis in Asia: Distinct Clinical Phenotypes and Implications for Long-Term Management

Eosinophilic esophagitis (EoE) has traditionally been regarded as a chronic, progressive inflammatory disorder associated with dysphagia, food impaction, and fibrostenotic remodeling. However, growing evidence from Asia suggests that EoE in Asian populations may exhibit distinct epidemiologic and clinical characteristics from those in Western cohorts. Recent studies from Asia have reported lower rates of fibrostenotic complications, greater responsiveness to proton pump inhibitors and potassium-competitive acid blockers, and a high prevalence of asymptomatic esophageal eosinophilia detected during routine screening endoscopy. Longitudinal studies have suggested that many Asian patients exhibit relatively mild inflammatory disease with limited progression, whereas severe fibrostenotic complications appear uncommon. Despite these phenotypic differences, molecular studies have indicated that the fundamental biology of EoE is largely conserved across geographic regions. These findings suggest that Asian and Western EoE likely represent the same underlying immune-mediated disease, with observed clinical differences potentially reflecting variation in disease stage at diagnosis, timing of diagnosis, healthcare systems, environmental exposures, and screening practices. Emerging data from Asia may also challenge the assumption that all patients with EoE inevitably require universal lifelong maintenance therapy. Current maintenance paradigms have largely been established from Western cohorts enriched for fibrostenotic disease and symptom-driven diagnosis, which may not fully represent the broader spectrum of EoE increasingly recognized in Asia. In this review, we summarize current evidence regarding geographic variation in EoE and discuss the potential implications of Asian disease phenotypes for individualized long-term management strategies.