An update on Eosinophilic Esophagitis

Abstract

Eosinophilic Esophagitis (EoE) is a chronic condition characterized by eosinophilic infiltration of the esophageal mucosa and symptoms resulting from esophageal dysfunction. The most important symptom is dysphagia, which causes an impaired quality of life and significant healthcare costs. Food allergies have a key role in the development of EoE: the removal of specific foods from the diet is sufficient to reduce esophageal inflammation and improve symptoms. The diagnosis of EoE is based on a combination of symptoms, eosinophilic infiltration and the absence of other conditions which can explain esophageal eosinophilia (mainly gastro-esophageal reflux disease). Diagnostic delay should be avoided because if left untreated, a fibrostenotic phenotype can develop with strictures. Current therapeutic approaches are based on the “3 D’s” concept: Dietary management, Drug therapy and esophageal Dilation. Dietary management can be based on an elemental diet (amino acid-based), which is rarely used in adults because of the poor palatability; an empiric elimination diet (2- 4-6 food elimination diet). Medical treatment is still the most commonly used approach in EoE. In particular, swallowed topic corticosteroids such as topical budesonide or fluticasone have been shown to be very effective in reducing esophageal inflammation. More recently, biological treatments have been evaluated as novel treatment options for EoE, targeting different cytokines or receptors in the Th2 immune reaction. Finally, in case of esophageal stricture, dilation is warranted.