- All ages, most common in 20s to 30s; male > female, 3:1
- Leading cause of dysphagia and food impaction in children and young adults
Incidence in general population is ~1 to 20/10,000 per year.
Gradually increasing, perhaps due to better case finding; 45 to 55/100,000
- Increased prevalence in patients with celiac disease
Etiology and Pathophysiology
- An atopic inflammatory disease; pathogenesis is an aberrant immune response to antigenic stimulation.
- Like eczema and asthma, T-helper 2 (TH2) lymphocytes play a role, as do mixed IgE and non–IgE-mediated allergic responses to food and environmental allergens.
- Although not well understood, the pathophysiology of EoE is postulated to be due to increased recruitment and activation of eosinophils in the esophagus by the eosinophil chemoattractants eotaxin-3, IL-5, and IL-13, which are ultimately responsible for inflammation and fibrotic change.
- EoE susceptibility may be caused by polymorphisms in thymic stromal lymphopoietin protein (TSLP).
- Potential new subphenotype of EoE (may also overlap with GERD): proton pump inhibitor (PPI)–responsive esophageal eosinophilia (REE), where PPIs may act to decrease the inflammatory response in EoE
- High rate of associated food and aero antigen allergies/anaphylaxis
There's more to see -- the rest of this topic is available only to subscribers.