Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Nov 22;47(1):230.
doi: 10.1186/s13052-021-01178-2.

Pediatric eosinophilic esophagitis: a review for the clinician

Simona Barni  1 , Stefania Arasi  2 , Carla Mastrorilli  3   4 , Luca Pecoraro  5   6 , Mattia Giovannini  7 , Francesca Mori  1 , Lucia Liotti  8 , Francesca Saretta  9 , Riccardo Castagnoli  10 , Lucia Caminiti  11 , Antonella Cianferoni #  12   13 , Elio Novembre #  1
Affiliations
Review

Pediatric eosinophilic esophagitis: a review for the clinician

Simona Barni et al. Ital J Pediatr. .

Abstract

Eosinophilic esophagitis (EoE) is a chronic clinical-pathologic disease characterized by eosinophilic infiltration of the esophageal epithelium with esophageal dysfunction symptoms.EoE can occur at any age and has different clinical manifestations depending on the age onset.To date, esophago-gastroduodenal endoscopy (EGD) with biopsy is the gold-standard for EoE diagnosis.According to the recent consensus guidelines, proton pump inhibitors, corticosteroids and elimination diets could be a first-line therapy option. The aim of the treatment is clinical and histological remission for preventing long-lasting untreatable fibrosis.A multidisciplinary approach (allergist, gastroenterology, dietitian, and pathologist) is recommended for managing patients affected by EoE, given the complexity of its treatment.This review will provide a practical guide to assist pediatricians treating children with EoE.Moreover, it highlights the unmet needs in diagnosis and treatment that require urgent attention from the scientific community in the aim of improving the management of patients with EoE.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Overview of EoE pathogenesis (adapted from reference [59]). Bas, Basophils; Eos, Eosinophils; IL, Interleukin; iLC2, innate lymphoid cells type 2; iNKT, invariant Natural Killer T cells; Mast, mast cells; Th, T helper cells. Allergens stimulate the esophageal epithelium inducing TSLP, leading to stimulation of Th2 cells, NK cells, mast cells, basophils, and iLC2. These cells induce IL-4 which promotes Th2 differentiation. IL-4 and IL-13 induced by Th2 cells induce eotaxin-3 (CCL26), which stimulates eosinophils to secrete IL-5. IL-5, secreted by Th2 cells and mast cells, stimulate eosinophils as well. Mast cells also induce TGF-b1 which stimulate eosinophils and fibroblasts. Furthermore, IL-13 induces impaired barrier function and tissue remodeling
Fig. 2
Fig. 2
Clinical manifestation and diagnostic algorithm for eosinophilic esophagitis (Modified from reference [62]). EGD, esophagogastroduodenoscopy; EoE, Eosinophilic Esophagitis; Eos, Eosinophils; GERD, gastroesophageal reflux disease; HPF, high-power field
Fig. 3
Fig. 3
Clinical practice algorithm for management of pediatric eosinophilic esophagitis (Modified from reference [–115]). PPI, proton-pump inhibitor
See this image and copyright information in PMC

References

    1. Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology [Internet] WB Saunders. 2018;154:319–332.e3. - PMC - PubMed
    1. Straumann A, Simon H-U. Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol [Internet] 2005;115(2):418–419. doi: 10.1016/j.jaci.2004.11.006. - DOI - PubMed
    1. Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, et al. Epidemiology of eosinophilic esophagitis over three decades in olmsted county, minnesota. Clin Gastroenterol Hepatol [Internet] Elsevier Inc. 2009;7:1055–1061. doi: 10.1016/j.cgh.2009.06.023. - DOI - PMC - PubMed
    1. van Rhijn BD, Verheij J, Smout AJPM, Bredenoord AJ. Rapidly increasing incidence of eosinophilic esophagitis in a large cohort. Neurogastroenterol Motil [Internet] 2013;25(1):47–e5. doi: 10.1111/nmo.12009. - DOI - PubMed
    1. Straumann A, Schoepfer A. Update on basic and clinical aspects of eosinophilic oesophagitis. Gut [Internet] 2014;63(8):1355–1363. doi: 10.1136/gutjnl-2013-306414. - DOI - PubMed