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Front Med (Lausanne). 2018 Oct 9;5:247. doi: 10.3389/fmed.2018.00247. eCollection 2018.

Eosinophilic Esophagitis: Review and Update.

Author information

1
Hospital General Universitario de Ciudad Real, Ciudad Real, Spain.
2
Hospital Central de la Cruz Roja San José y Santa Adela, Madrid, Spain.
3
Hospital San Pedro de Alcántara, Cáceres, Spain.
4
Hospital Universitario Virgen del Rocío, Seville, Spain.
5
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
6
Hospital Infanta Sofía, Madrid, Spain.
7
Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
8
Hospital Virgen del Valle, Toledo, Spain.
9
Hospital General Universitario de Albacete, Albacete, Spain.
10
Hospital Universitario Fundación Alcorcón, Alcorcón, Spain.
11
Hospital UniversitarioReina Sofía de Córdoba, Cordoba, Spain.
12
Hospital Universitario Infanta Leonor, Madrid, Spain.
13
Hospital Universitario de Araba, Vitoria-Gasteiz, Spain.
14
Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain.
15
Hospital Santa Barbara, Puertollano, Spain.
16
Allergy Section, Hospital Universitario de La Laguna, San Cristóbal de La Laguna, Spain.
17
Allergy Section, Pneumology Department, Hospital Clínic Universitat de Barcelona, Barcelona, Spain.

Abstract

Background: Eosinophilic esophagitis (EoE) was first described in the 1990s, showing an increasing incidence and prevalence since then, being the leading cause of food impaction and the major cause of dysphagia. Probably, in a few years, EoE may no longer be considered a rare disease. Methods: This article discusses new aspects of the pathogenesis, symptoms, diagnosis, and treatment of EoE according to the last published guidelines. Results: The epidemiological studies indicate a multifactorial origin for EoE, where environmental and genetic factors take part. EoE affects both children and adults and it is frequently associated with atopic disease and IgE-mediated food allergies. In patients undergoing oral immunotherapy for desensitization from IgE-mediated food allergy the risk of developing EoE is 2.72%. Barrier dysfunction and T-helper 2 inflammation is considered to be pathogenetically important factors. There are different patterns of clinical presentation varying with age and can be masked by adaptation habits. Besides, symptoms do not usually correlate with histologic disease activity. The diagnostic criteria for EoE has evolved but mainly requires symptoms of esophageal dysfunction with histologic evidence of a peak value of at least 15 eosinophils per high-power field. Endoscopies have to be repeated in order to diagnose, monitor, and treat EoE. Treatment of EoE can be started either by drugs (PPIs and topical corticosteroids) or elimination diets. The multistage step-up elimination diet management approach of EoE is promising. Endoscopic dilation is used for patients with severe dysphagia/food impaction with inadequate response to anti-inflammatory treatment. Conclusions: Research in recent years has contributed to a better understanding of EoE's pathogenesis, genetic background, natural history, allergy workup, standardization in assessment of disease activity, evaluation of minimally invasive diagnostic tools, and new therapeutic approaches. However, several unmet needs are to be solved urgently, as finding a non-invasive disease-monitoring methods and biomarkers for routine practice, the development or new therapies, novel food allergy testing to detect triggering foods, drug, and doses required for initial therapy and safety issues with long-term maintenance therapy, amongst others. Besides, multidisciplinary management units of EoE, involving gastroenterologists, pediatricians, allergists, pathologists, dietitians, and ENT specialists are needed.

KEYWORDS:

allergens; elimination diet; eosinophilic esofagitis; eosinophilics; esophagoscopy

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