Abstract
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation, whose incidence is rising. It significantly affects patients’ quality of life and, if left untreated, results in fibrotic complications. Although broad consensus has been achieved on first-line therapy, a subset of patients remains non-responder to standard therapy. The pathogenesis of EoE is multifactorial and results from the complex, still mostly undefined, interaction between genetics and intrinsic factors, environment, and antigenic stimuli. A deep understanding of the pathophysiology of this disease is pivotal for the development of new therapies. This review provides a comprehensive description of the pathophysiology of EoE, starting from major pathogenic mechanisms (genetics, type 2 inflammation, epithelial barrier dysfunction, gastroesophageal reflux, allergens, infections and microbiota) and subsequently focusing on the single protagonists of type 2 inflammation (involved cells, cytokines, soluble effectors, surface proteins and transcription factors) that could represent present and future therapeutic targets, while summarizing previous therapeutic approaches in literature.
Highlights
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation (Dellon and Hirano, 2018).Eosinophilic esophagitis can affect all age groups, with an incidence peak between the third and the fifth decade of life
The aim of this review is to provide a comprehensive description of the pathophysiology of EoE with a particular focus on therapeutic targets and results from previous therapeutic approaches in literature
A pilot study on pediatric patients with milk-induced EoE treated with Epicutaneous immunotherapy (EPIT) found no significant difference between groups for the maximum eosinophil count at the end of the study
Summary
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation (Dellon and Hirano, 2018). Eosinophilic esophagitis can affect all age groups, with an incidence peak between the third and the fifth decade of life. Its estimated prevalence is 30–100/100.000 in the adult population and 29– 42/100.000 in the pediatric population (Soon et al, 2013; Dellon et al, 2014a; Arias et al, 2016). EoE is most frequent in males, with a male-to-female ratio of about 3:1 (Hruz, 2014) and a predilection for Caucasian ethnicity (Arias et al, 2016)
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