EoE ToT Module 4 References-Spechler et al Am J Gastroenerol 2007 Thoughts on the complex relationship between GERD and EoE

Spechler et al Am J Gastroenerol 2007 Thoughts on the complex relationship between GERD and EoE

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The relationship between Gastroesophageal Reflux Disease (GERD) and Eosinophilic Esophagitis (EoE) is complex and multifaceted. Recent findings suggest that differentiating between these two conditions, which may present with similar symptoms such as heartburn and dysphagia, is challenging and possibly simplistic. This report explores four potential interactions between GERD and EoE: (1) GERD causing mild eosinophilic infiltration due to esophageal injury, (2) coexistence of GERD and EoE as unrelated conditions, (3) EoE contributing to or causing GERD, and (4) GERD contributing to or causing EoE.<br /><br />Histological examination revealing eosinophils in the esophageal squamous epithelium, typically considered abnormal and indicative of disease, is crucial for diagnosing EoE. The criteria for eosinophil density remain debated, although indicative figures are provided. While GERD might also present with eosinophils in the distal esophagus, especially in children, distinguishing it from EoE based solely on this finding remains problematic.<br /><br />The report suggests EoE presents itself with a higher-than-expected rate of pathological acid reflux, particularly in adults, indicating a non-random overlap with GERD. This hints at either EoE exacerbating or causing GERD or the reverse. Mechanistically, GERD might increase eosinophil infiltration through acid-induced endothelial changes, enhanced esophageal blood flow, and cytokine-mediated effects. Conversely, EoE could influence GERD by releasing substances that affect esophageal motility or increase mucosal susceptibility to acid injury.<br /><br />Considering these interconnections, it is recommended to trial proton pump inhibitor (PPI) therapy even if EoE is suspected, as a favorable response to PPIs does not necessarily negate an EoE diagnosis. This approach may help manage symptoms more effectively while acknowledging the intricate relationship between GERD and EoE.<br /><br />The study calls for more extensive research to better define the mechanisms underlying each interaction and to improve diagnostic and therapeutic strategies for these overlapping esophageal disorders.

Keywords

GERD

EoE

heartburn

dysphagia

eosinophils

proton pump inhibitor

esophageal injury

acid reflux

diagnosis

therapy