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Clinical Reviews in Allergy & Immunology

, Volume 50, Issue 2, pp 159–174 | Cite as

Eosinophilic Esophagitis: A Comprehensive Review

  • Antonella Cianferoni
  • Jonathan Spergel
Article

Abstract

Eosinophilic esophagitis (EoE) is an emerging chronic atopic clinical-pathologic disease with an estimated prevalence of 1/1000 similar to the one of Crohn’s diseases. Usually, EoE is firstly suspected due to symptoms that are caused by esophageal dysfunction and/or fibrosis. EoE diagnosis is confirmed if the esophageal biopsy shows at least 15 eosinophils per high power field (eos/hpf) as a peak value in one or more of at least four specimens obtained randomly from the esophagus. Most of the patients affected by EoE have other atopic diseases such as allergic rhinitis, asthma, IgE-mediated food allergies, and/or atopic dermatitis. The local inflammation is a T helper type 2 (Th2) flogosis, which most likely is driven by a mixed IgE and non-IgE-mediated reaction to food and/or environmental allergens. Recently published genetic studies showed also that EoE is associated with single nucleotide polymorphism (SNP) on genes which are important in atopic inflammation such as thymic stromal lymphopoietin (TSLP) located close to the Th2 cytokine cluster (IL-4, IL-5, IL-13) on chromosome 5q22. When the EoE diagnosis is made, it is imperative to control the local eosinophilic inflammation not only to give symptomatic relief to the patient but also to prevent complications such as esophageal stricture and food impaction. EoE is treated like many other atopic diseases with a combination of topical steroids and/or food antigen avoidance.

Keywords

Eosinophilic esophagitis Genome-wide association study Th2 inflammation 

Abbreviations

APC

Antigen-presenting cells

CHOP

The Children’s Hospital of Philadelphia

DC

Dendritic cells

CAG

Center for Applied Genomics

CRTH2

Chemoattractant receptor expressed on Th2 cells

DSG-1

Desmoglein-1

EGD

Esophago-gastroduodenal endoscopy

EoE

Eosinophilic esophagitis

eos

Eosinophils

GERD

Gastro-esophageal reflux

hpf

High power field

IBD

Inflammatory bowel disease

IL

Interleukin

iNKT

Invariant-natural killer cells

LC

Langerhans cells

PG2

Prostaglandin D2

PPI

Proton pump inhibitors

R

Receptor

SNP

A small nuclear polymorphism

TNFα

Tumor necrosis factor alpha

TGFβ

Transforming growth factor beta

Th2

T helper type 2

TSLP

Thymic stromal lymphopoietin

Notes

Funding

Institutional Support from The Department of Pediatrics, The Children’s Hospital of Philadelphia, and Joint Center for Gastroenterology and Nutrition of CHOP-HUP, and The CHOP Food Allergy Family Research Fund

Conflict of Interest

None

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Division of Allergy and ImmunologyThe Children’s Hospital of PhiladelphiaPhiladelphiaUSA
  2. 2.Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaUSA

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