EoE Module 1 References-Dellon et al Gastroenterology 2018 Epidemiology and natural history of eosinophilic esophagitis

Dellon et al Gastroenterology 2018 Epidemiology and natural history of eosinophilic esophagitis

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Eosinophilic Esophagitis (EoE) has become a significant cause of upper gastrointestinal morbidity over the past two decades, with rapidly evolving epidemiology. Characterized by symptoms of esophageal dysfunction and esophageal mucosal eosinophilic infiltration, EoE has transformed from a rare condition to a common diagnosis in gastroenterology clinics and emergency settings, leading to increased healthcare costs.<br /><br />The incidence of EoE is rising more rapidly than can be explained by increased recognition alone, suggesting significant environmental factors. Current data estimates the incidence at 5-10 cases per 100,000 persons and the prevalence at 0.5-1 case per 1000. This increase has been noted across various regions, including North America, Europe, and some parts of Asia and Australia, but not in sub-Saharan Africa or India.<br /><br />Several risk factors are implicated in EoE, such as food and environmental allergens, early life exposures like antibiotic use and Cesarean deliveries, and an inverse relationship with Helicobacter pylori infections. EoE is often seen in patients with allergic conditions and some connect the disease to the hygiene hypothesis. Other potential risk factors include rural living, cold or arid climates, and genetic predispositions.<br /><br />The natural history of EoE reveals a progression from inflammation to fibrosclerosis. Longitudinal studies indicate that untreated EoE leads to esophageal remodelling and stricture formation, making the duration of untreated disease a significant predictor of stricture risk. While spontaneous remission can occur, it is uncommon, highlighting the importance of early and sustained treatment. Therapeutic options such as dietary modifications, medical treatments, and endoscopic interventions are essential for managing both inflammation and progression to esophageal fibrosis.<br /><br />Future research is needed to fully comprehend the etiology and progression of EoE, focusing on long-term outcomes and the identification of factors that influence disease severity. Understanding these dynamics will aid in developing better management strategies and improving patient prognoses.

Keywords

Eosinophilic Esophagitis

esophageal dysfunction

mucosal eosinophilic infiltration

gastroenterology

environmental factors

prevalence

risk factors

esophageal fibrosis

dietary modifications

long-term outcomes