Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic, local, immune-mediated, inflammatory disease localized in the esophagus.1

EoE is characterized by eosinophilic inflammation, which is thought to be triggered by exposure to aero- or food allergens, and can lead to esophageal dysfunction.1,2

Eosinophilic esophagitis illustration

Epidemiology

The incidence and prevalence of eosinophilic esophagitis have steadily increased over time. Approximately 1 in 2000 people in the U.S. live with EoE.2,3 EoE is often accompanied by other comorbidities, and has a strong association with atopic disease.1,4,5 Clinicians should maintain a high index of suspicion of EoE, regardless of age, race or sex; however, EoE is approximately twice as common in men vs women and more common among White people, with symptoms varying by age.6

Diagnosis

The diagnosis of EoE is dependent on clinical, endoscopic, and histologic findings. These findings include symptoms of esophageal dysfunction; endoscopic findings of rings, furrows, exudates, edema, stricture, narrowing, and crepe-paper mucosa; and eosinophilic infiltration, which is defined as ≥15 eosinophils per high power field (eos/hpf) on an esophageal biopsy, that is isolated to the esophagus.7 A diagnosis of EoE is not reliant on prior response to proton pump inhibitors (PPIs). EoE should be suspected if a patient presents with chronic signs and symptoms of esophageal dysfunction such as: dysphagia, food impaction, food refusal, failure to progress with food introduction, heartburn, regurgitation, vomiting, chest pain, odynophagia, abdominal pain and malnutrition.

Pathophysiology

The pathophysiology of EoE involves the production of pro-inflammatory cytokines that promote the recruitment and proliferation of immune effector cells, such as eosinophils, at the site of inflammation. This chronic inflammation, localized to the esophagus can disrupt normal epithelial integrity.2,8,9 If left untreated, the disease can progress to a fibrostenotic phenotype with esophageal remodeling and dysmotility.1,10,11

Navigating EoE

The symptoms and impact of EoE can vary by age.1,12 Infants and toddlers with EoE may experience vomiting, food refusal, choking with meals, and sleep disturbances. Children may experience dysphagia, choking and gagging with certain foods, food impactions, pain, nausea and vomiting, sleep disturbances, and decreased appetite. Adults may report dysphagia, food impaction, food avoidance, intractable heartburn, regurgitation, and chest pain. Surveys of patients with EoE suggest their greatest concerns relate to difficulty swallowing and the overall impact on eating.13,14 Symptomatic improvement has been shown to be a key endpoint of therapy.15,16