Abstract
Eosinophilic esophagitis (EoE) is a chronic immune antigen-mediated disorder characterized by symptoms of esophageal dysfunction in combination with dense esophageal eosinophilia. The clinical presentation of EoE can vary depending on children's age and their ability to report symptoms, therefore a high index of suspicion for EoE is required because children and teenagers may develop coping strategies around eating. The development of symptoms measurement tools in EoE assists in not only assessing symptoms, but also coping strategies children may have developed. While the diagnosis of EoE requires endoscopic evaluation with histologic assessment of esophageal mucosal biopsy samples, several emerging methods to assess and survey the esophageal mucosa have been developed. Advances in the field to better understand the natural history, clinical and molecular features of phenotypes in EoE will be important in considering novel therapeutic options and assessing outcomes.
Highlights
Since the advent of flexible endoscopy in the 1960’s, gastroesophageal reflux disease (GERD) was identified as the most common cause of gross and histological evidence of esophagitis
eosinophilic esophagitis (EoE) is a chronic immune antigen-mediated disorder characterized by dense esophageal eosinophilia with symptoms of esophageal dysfunction [4]
Infants and young children can present with vague symptoms including feeding difficulties that lead to prolonged mealtimes, food refusal, gagging or GERDlike symptoms such as heartburn, regurgitation or vomiting [4, 18]
Summary
Since the advent of flexible endoscopy in the 1960’s, gastroesophageal reflux disease (GERD) was identified as the most common cause of gross and histological evidence of esophagitis. Infants and young children can present with vague symptoms including feeding difficulties that lead to prolonged mealtimes, food refusal, gagging or GERDlike symptoms such as heartburn, regurgitation or vomiting [4, 18] In these circumstances, a high index of suspicion is needed for EoE since oftentimes patients have developed coping strategies to ensure that food products can continue to be consumed. Patients with more of a fibrostenotic phenotype [27, 28] may present with food impactions or severe dysphagia, have endoscopic findings suggestive of esophageal narrowing or esophageal stricture [27, 28], and have histologic evidence of lamina propria fibrosis. Future studies determining key therapeutic targets in this group may allow for earlier detection and novel treatment approaches Another phenotype are patients with EoE type symptoms, dense esophageal eosinophilia, who respond both clinically and histologically to high doses of proton pump inhibitors (PPIs) [29]. Eosinophilic microabscesses and eosinophil layering of the surface epithelium can be seen [45]
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