Eosinophilic Esophagitis

Basics

Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized clinically by variable symptoms of esophageal dysfunction and pathologically by localized eosinophilic inflammation.
The diagnosis is established in symptomatic patients who have the following:
- At least 15 eosinophils/high powered field (HPF) confined to the esophagus on endoscopic biopsies
- Reliable exclusion of other potential causes of esophageal eosinophilia
- Persistent eosinophilic infiltrate in esophageal biopsies after a trial of high-dose proton pump inhibitor (PPI) therapy

Incidence rates are 5.1 and 7 per 100,000 person-years in children and adults, respectively.
Prevalence in children is 29.5, lower than 43.4 per 100,000 in adults, and higher in United States compared to Europe.
3:1 male-to-female ratio
Peaks of onset in childhood and 3rd to 4th decade

The exact pathophysiology of EoE is unknown but likely involves an immune response to environmental antigens in genetically predisposed individuals.
Environmental factors (food and possibly aeroallergens) trigger inflammatory response mediated by T-helper type 2 (Th2) cells.
Genetic polymorphisms which predispose to EoE include eotaxin-3, thymic stromal lymphopoietin, and calpain-14.

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