Eosinophilic esophagitis: Current concepts in diagnosis and treatment

Abstract

Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. Its symptoms, which include heartburn, regurgitation, and esophageal stenosis (with dysphagia being more frequent in eosinophilic esophagitis in young adults and children), are similar to those of gastroesophageal reflux disease, causing delays in diagnosis and treatment. Although endoscopic findings such as furrows, esophageal mucosa trachealization, and whitish exudates may suggest its presence, this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia (parasitic infections, hypereosinophilic syndrome, inflammatory bowel disease, among others) for which treatment could be initiated. Currently, the 3 "D"s ("Drugs, Diet, and Dilation") are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. Herein, the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed, in addition to evidence for the various treatments.

Keywords: Corticoid; Diet; Dilation; Eosinophilic esophagitis; Esophageal stenosis; Proton pump inhibitor.

Figure 1

Pathophysiology of eosinophilic esophagitis. TSLPr: TSLP receptor; IL-4r: IL-4 receptor; Eo: Eosinophils; Bas: Basophils; Mas: Mast cells; NK: Natural killer cells; PO: Periostin.

Figure 2

Longitudinal furrows in the esophagus.

Figure 3

Whitish exudate in the esophagus and trachealized esophagus.

Figure 4

Superficial tear of the proximal esophageal mucosa.

Figure 5

Trachealized mucosa of the esophagus.