Eosinophilic Esophagitis

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DESCRIPTION

  • 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 by the following:
    • Symptoms attributable to esophageal dysfunction
    • At least 15 eosinophils per high-power field (HPF) confined to the esophagus on endoscopic biopsies
    • Reliable exclusion of other potential causes of esophageal eosinophilia
    • A trial of proton pump inhibitors (PPIs) is not recommended prior to endoscopy because some patients with EoE respond to PPIs, and this treatment could mask a diagnosis.

EPIDEMIOLOGY

  • Incidence rates are 5.1 and 7 per 100,000 person-years in children and adults, respectively.
  • Prevalence in children is 29.5, <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
  • Affects all races and ethnicities with yet to be documented incidences

PATHOPHYSIOLOGY

  • A variety of mechanisms likely explain the mucosal eosinophilia observed in EoE that are related to dysregulation of Th2 immune pathways and underlying barrier dysfunction.
  • These dysregulated responses are often triggered by food or other environmental antigens in genetically predisposed individuals.
  • Different endotypes may explain differences in clinical presentations observed in atopic or stenotic patients.
  • Genetic polymorphisms which predispose to EoE include eotaxin-3, thymic stromal lymphopoietin, and calpain-14.

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