ADVANCES IN THE DIAGNOSIS AND TREATMENT OF EOSINOPHILIC ESOPHAGITIS

Abstract

Eosinophilic esophagitis (EoE) is mainly a non-IgE-mediated (Th2-cell-mediated) immunological chronic condition that is characterized by clinical symptoms related to esophageal dysfunction and histologically intense eosinophilic inflammation in the esophagus, leading to long-term esophageal narrowing or strictures. EoE has increasingly been implicated as a major cause of dysphagia and food impaction in middle-aged men in Western countries during the previous two decades. This disease is independently distinct from eosinophilic gastroenteritis that can affect the entire gastrointestinal tract including the esophagus. Recognizing characteristic endoscopic findings, such as linear furrows, rings, and white exudates, enables definitive histological diagnosis of this clinicopathological disease. The treatment of EoE involves diet therapy or pharmacological therapy; however, relapse is common if treatment is discontinued. A proton-pump inhibitor (PPI) is now used as a first-line pharmacological agent, and topical steroid is strongly recommended for non-PPI-responsive esophageal eosinophilia owing to fewer adverse effects. Successful diet therapy is challenging in the general clinical setting because it warrants very strict management by many specialists. Clinicians need to understand this emerging esophageal inflammatory disease that induces chronic dysphagia and food impaction.