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Highlights & Basics
- Eosinophilic esophagitis (EoE) is a chronic immune-mediated/allergen-mediated condition defined clinically by symptoms of esophageal dysfunction, and pathologically by an eosinophilic infiltration of the esophageal epithelium in the absence of secondary causes of local or systemic eosinophilia.
- To consider the diagnosis, there must be an esophageal epithelial infiltrate of ≥15 eosinophils per high-power microscopy field on esophageal biopsy.
- Incidence and prevalence are increasing at a rate that is outpacing increased recognition and diagnosis; it is more commonly seen in children and young adults.
- Medications (usually topical/swallowed corticosteroids or proton-pump inhibitors) or dietary elimination can be used as a first-line treatment, with endoscopic dilation reserved for patients with esophageal strictures or fibrostenotic complications.
- Prognosis is good, with the majority of patients having a good response to either pharmacologic or dietary elimination therapy.
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Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011 Jul;128(1):3-20.[Abstract][Full Text]
Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007 Oct;133(4):1342-63.[Abstract][Full Text]
Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459-87.[Abstract][Full Text]
Wolf WA, Jerath MR, Sperry SL, et al. Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2014 Aug;12(8):1272-9.[Abstract][Full Text]
Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017 Apr;5(3):335-58.[Abstract][Full Text]
Hirano I, Chan ES, Rank MA, et al. AGA institute and the joint task force on allergy-immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2020 May;124(5):416-23.[Abstract][Full Text]
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38. Peterson KA, Byrne KR, Vinson LA, et al. Elemental diet induces histologic response in adult eosinophilic esophagitis. Am J Gastroenterol. 2013 May;108(5):759-66.[Abstract]
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52. Jensen ET, Hoffman K, Shaheen NJ, et al. Esophageal eosinophilia is increased in rural areas with low population density: results from a national pathology database. Am J Gastroenterol. 2014 May;109(5):668-75.[Abstract][Full Text]
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54. Wolf WA, Jerath MR, Sperry SL, et al. Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2014 Aug;12(8):1272-9.[Abstract][Full Text]
55. Lucendo AJ, Arias Á, González-Cervera J, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy Clin Immunol. 2013 Mar;131(3):797-804.[Abstract][Full Text]
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57. Gonsalves N, Yang GY, Doerfler B, et al. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology. 2012 Jun;142(7):1451-9.[Abstract][Full Text]
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63. Blanchard C, Mingler MK, Vicario M, et al. IL-13 involvement in eosinophilic esophagitis: transcriptome analysis and reversibility with glucocorticoids. J Allergy Clin Immunol. 2007 Dec;120(6):1292-300.[Abstract][Full Text]
64. van Rhijn BD, Weijenborg PW, Verheij J, et al. Proton pump inhibitors partially restore mucosal integrity in patients with proton pump inhibitor-responsive esophageal eosinophilia but not eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2014 Nov;12(11):1815-23.[Abstract][Full Text]
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69. Rawson R, Anilkumar A, Newbury RO, et al. The TGFbeta1 promoter SNP C-509T and food sensitization promote esophageal remodeling in pediatric eosinophilic esophagitis. PLoS One. 2015 Dec 14;10(12):e0144651.[Abstract][Full Text]
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72. Beppu LY, Anilkumar AA, Newbury RO, et al. TGF-beta1-induced phospholamban expression alters esophageal smooth muscle cell contraction in patients with eosinophilic esophagitis. J Allergy Clin Immunol. 2014 Nov;134(5):1100-7.[Abstract][Full Text]
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76. Kottyan LC, Davis BP, Sherrill JD, et al. Genome-wide association analysis of eosinophilic esophagitis provides insight into the tissue specificity of this allergic disease. Nat Genet. 2014 Aug;46(8):895-900.[Abstract][Full Text]
77. Alexander ES, Martin LJ, Collins MH, et al. Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis. J Allergy Clin Immunol. 2014 Nov;134(5):1084-92.[Abstract][Full Text]
78. Sherrill JD, Gao PS, Stucke EM, et al. Variants of thymic stromal lymphopoietin and its receptor associate with eosinophilic esophagitis. J Allergy Clin Immunol. 2010 Jul;126(1):160-5.[Abstract][Full Text]
79. Davis BP, Stucke EM, Khorki ME, et al. Eosinophilic esophagitis-linked calpain 14 is an IL-13-induced protease that mediates esophageal epithelial barrier impairment. JCI Insight. 2016 Apr;1(4):e86355.[Abstract][Full Text]
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116. Molina-Infante J, Lucendo AJ. Update on topical steroid therapy for eosinophilic esophagitis. Gastroenterol Hepatol. 2015 Jun-Jul;38(6):388-97.[Abstract][Full Text]
117. Dellon ES, Woosley JT, Arrington A, et al. Efficacy of budesonide vs fluticasone for initial treatment of eosinophilic esophagitis in a randomized controlled trial. Gastroenterology. 2019 Jul;157(1):65-73.[Abstract][Full Text]
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