EoE ToT Module 6 References-Roussel et al StatPearls Aug 8 2023 Eosinophilic Esophagitis - StatPearls

Roussel et al StatPearls Aug 8 2023 Eosinophilic Esophagitis - StatPearls - NCBI Bookshelf

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Eosinophilic Esophagitis (EoE) is a chronic immune/antigen-mediated esophageal condition characterized by esophageal dysfunction and mucosal inflammation primarily involving eosinophils. Once thought to be part of gastroesophageal reflux disease (GERD), EoE is now recognized as a distinct entity. The condition is triggered by various environmental, genetic, and immune factors, often linked to food allergens and atopic conditions like asthma and dermatitis.<br /><br />Epidemiologically, EoE affects both pediatric and adult populations globally, except for Africa. Prevalence is notably higher in boys and in Caucasian men in their 20s and 30s.<br /><br />Pathophysiologically, EoE involves a strong immunogenic reaction to antigens leading to eosinophil recruitment and inflammation in the esophageal mucosa. Key cytokines involved include TSLP, IL5, IL13, IL15, and TGF-B, leading to mucosal remodeling and fibrosis, which manifest clinically as dysphagia, chest pain, and food impaction.<br /><br />Diagnosing EoE involves clinical evaluation, endoscopy with biopsies from various parts of the esophagus, and histopathological examination revealing eosinophils and other inflammatory markers. Differential diagnoses include GERD, achalasia, celiac disease, Crohn's disease, drug hypersensitivity, and connective tissue disorders.<br /><br />Treatment aims at symptom control and reducing eosinophil count through dietary, pharmacological, and endoscopic interventions. Dietary management includes eliminating specific allergens or following a six-food elimination diet, sometimes requiring an elemental diet. Pharmacologically, proton pump inhibitors (PPIs) are tried first, followed by topical steroids if needed. Endoscopic management is reserved for cases with persistent symptoms or food impaction, often involving esophageal dilation.<br /><br />Optimal patient outcomes are achieved with interprofessional care, emphasizing role coordination among gastroenterologists, primary care providers, pathologists, allergists, and other specialists. Accurate diagnosis and adherence to dietary and medication regimens are crucial for managing EoE effectively.

Keywords

Eosinophilic Esophagitis

EoE

esophageal dysfunction

mucosal inflammation

food allergens

dysphagia

endoscopy

dietary management

topical steroids

interprofessional care