EoE ToT Module 6 References-Collins Dig Dis 2014 Histopathology of eosinophilic esophagitis

Collins Dig Dis 2014 Histopathology of eosinophilic esophagitis

Pdf Summary

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease driven by antigenic stimuli, characterized by esophageal dysfunction and eosinophil-predominant inflammation. Diagnosis of EoE requires both clinical and histological assessments, as neither alone is sufficient. The most defining histopathologic feature is the presence of at least 15 intraepithelial eosinophils per high-power field (HPF), which often aligns with other inflammatory cells and tissue changes like basal layer hyperplasia and dilated intercellular spaces.<br /><br />Differential diagnosis for EoE includes conditions such as gastroesophageal reflux disease (GERD) and proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). EoE pathology does not vary significantly with age, sex, or familial predisposition. However, a flare in word-count methods, especially the variability in the size of microscopic fields among different labs, challenges counting eosinophils.<br /><br />Dietary management, topical steroids, and novel biologics like monoclonal antibodies are primary therapies. Treatment often normalizes histology, though symptoms might persist due to potentially hidden neuromuscular dysfunction not sampled during endoscopic biopsies. Multiple biopsies, up to five, from different esophageal locations can improve diagnostic accuracy given the patchy distribution of eosinophils.<br /><br />Genetic studies have identified a unique transcriptome for EoE, highlighting genes like periostin, thymic stromal lymphopoietin (TSLP), and desmoglein, which are linked to the disease pathology. The inflammation in EoE includes increased eosinophils, lymphocytes, and mast cells, and evaluating these cell types alongside clinical symptoms improves diagnosis.<br /><br />Inflammatory markers, including Eotaxin-3 and microRNAs, show dysregulation in EoE, and therapies like swallowed corticosteroids significantly reduce inflammation. However, therapeutic response may vary, with clinical improvements sometimes lagging behind histological resolution. Genetic profiling and molecular diagnostics are emerging as valuable tools in understanding and managing EoE. <br /><br />Ultimately, EoE exemplifies a clinicopathologic and genopathologic entity requiring integrated diagnosis and treatment strategies.

Keywords

Eosinophilic esophagitis

chronic inflammatory disease

esophageal dysfunction

histopathologic feature

differential diagnosis

dietary management

topical steroids

genetic studies

inflammatory markers

molecular diagnostics