[EOSINOPHILIC ESOPHAGITIS: MUCH MORE IS UNKNOWN YET THAN DISCOVERED]

Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus, which is mediated by Th2 cells that could start at any age, from early childhood to adulthood. The pathogenesis of the disease is not fully understood, but apparently it consists of a combined interaction between hereditary and environmental factors. Over the years, EoE has become an increasingly diagnosed disease in the context of esophageal symptoms. Nowadays, it is considered the second most common cause of chronic esophagitis and dysphagia (after GERD which is the leading cause on the list). The hallmark of the disease is the presence of eosinophils in the esophageal mucosa (> 15 eosinophil/HPF). Clinically, EoE is characterized by various esophageal symptoms, ranging from mild dysphagia to complications that eventually appear, including esophageal food impaction which usually requires urgent endoscopic removal. Long term complications occur as a result of a defective remodeling process of the inflamed esophagus, which includes histological changes of fibrosis, angiogenesis, and smooth muscle hypertrophy. Due to its progressive course, treatment of the disease requires a close and long-term managerial and therapeutic strategy. There are currently a variety of treatment options for the disease depending on its degree and severity, starting with dietary treatment, pharmacological therapy and ending with esophageal dilations if necessary.