Eosinophilic Esophagitis

Eosinophilic Esophagitis is a topic covered in the 5-Minute Pediatric Consult.

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Basics

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 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

Epidemiology

  • 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

Pathophysiology

  • 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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