Eosinophilic esophagitis. Beyond the diet.

Abstract

Eosinophilic esophagitis is a chronic, progressive, immune-mediated (Th2 antigen) disease that exclusively affects the esophagus. It is characterized histologically by intraepithelial infiltration of eosinophils (> 15 eosinophils per high-power field), leading to esophageal dysfunction, primarily manifested as dysphagia and food impaction. Initially, it is an inflammatory disease that can progress to a fibrostenotic pattern and is considered the most common cause of chronic dysphagia and esophagitis, second only to gastroesophageal reflux disease. As such, it currently represents the second most common cause of chronic esophagitis and the leading cause of dysphagia and food impaction in children and young adults, accounting for 7% of endoscopic diagnoses of esophageal symptoms.

EoE is considered an emerging disease with increasing incidence, likely due to the widespread use of upper gastrointestinal endoscopy in the evaluation of gastrointestinal pathology, alongside greater awareness and recognition of this condition by endoscopists and clinicians.

As a chronic disease that can progress to a fibrotic pattern, early detection and appropriate treatment are crucial.

In this review, we examine the current management of eosinophilic esophagitis, reviewing the latest evidence on the various treatment options. We analyze the therapeutic approach to follow based on the disease pattern, potential clinical and endoscopic follow-up for maintenance treatment, as well as the possibility of treatment discontinuation in selected cases.

Keywords: eosinophilic esophagitis, PPI, topical steroids, dupilumab, empiric diet.