Eosinophilic Esophagitis

Eosinophilic Esophagitis is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

  • Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized clinically by variable symptoms of esophageal dysfunction and pathologically by localized eosinophilic inflammation.
  • The diagnosis is established in symptomatic patients who have the following:
    • At least 15 eosinophils/HPF isolated to the esophagus on endoscopic biopsies
    • Persistent eosinophilic infiltrate in esophageal biopsies after a trial of proton pump inhibitor (PPI) therapy

Epidemiology

  • Incidence rates range from 0.7 to 10 per 100,000 person-years, and prevalence from 0.2 to 43 per 100,000.
  • 3:1 male-to-female ratio
  • Peaks of onset in childhood and 3rd–4th decade

Pathophysiology

  • The exact pathophysiology of EoE is unknown but likely involves an immune response to environmental antigens in genetically predisposed individuals.
  • Environmental factors (food and possibly aeroallergens) trigger inflammatory response mediated by type 2 T-helper (Th2) cells.
  • Genetic polymorphisms which predispose to EoE include eotaxin-3, thymic stromal lymphopoietin, and filaggrin.

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Basics

Description

  • Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized clinically by variable symptoms of esophageal dysfunction and pathologically by localized eosinophilic inflammation.
  • The diagnosis is established in symptomatic patients who have the following:
    • At least 15 eosinophils/HPF isolated to the esophagus on endoscopic biopsies
    • Persistent eosinophilic infiltrate in esophageal biopsies after a trial of proton pump inhibitor (PPI) therapy

Epidemiology

  • Incidence rates range from 0.7 to 10 per 100,000 person-years, and prevalence from 0.2 to 43 per 100,000.
  • 3:1 male-to-female ratio
  • Peaks of onset in childhood and 3rd–4th decade

Pathophysiology

  • The exact pathophysiology of EoE is unknown but likely involves an immune response to environmental antigens in genetically predisposed individuals.
  • Environmental factors (food and possibly aeroallergens) trigger inflammatory response mediated by type 2 T-helper (Th2) cells.
  • Genetic polymorphisms which predispose to EoE include eotaxin-3, thymic stromal lymphopoietin, and filaggrin.

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