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Clinical Reviews in Allergy & Immunology

, Volume 55, Issue 1, pp 19–42 | Cite as

Pathophysiology of Eosinophilic Esophagitis

  • Benjamin P. Davis
Article

Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus associated with an atopic predisposition which appears to be increasing in prevalence over the last few decades. Symptoms stem from fibrosis, swelling, and smooth muscle dysfunction. In the past two decades, the etiology of EoE has been and is continuing to be revealed. This review provides an overview of the effects of genetics, environment, and immune function including discussions that touch on microbiome, the role of diet, food allergy, and aeroallergy. The review further concentrates on the pathophysiology of the disease with particular focus on the important concepts of the molecular etiology of EoE including barrier dysfunction and allergic hypersensitivity.

Keywords

Aeroallergy Basophil Epithelial-to-mesenchymal transition Eosinophilic esophagitis Eosinophil Esophagus Esophagitis Food allergy Innate lymphoid cells Invariant natural killer T cells Microbiome Squamous epithelium 

Abbreviations

AD

Atopic dermatitis

AEC

Absolute eosinophil count

ALI

Air-liquid interface

ALOX15

Arachidonate-15 lipooxygenase

APCs

Antigen-presenting cells

APT

Atopy patch test

CAPN14

Calpain 14

CDH26

Cadherin-like 26

CPA3A

Carboxypeptidase 3A

CRLF2

Cytokine receptor–like factor 2

CRS

Chronic rhinosinusitis

CRTH2

Chemoattractant receptor expressed on Th2 cells

CTDs

Connective tissue disorders

DOCK8

Dedicator Of cytokinesis 8

DSG1

Desmoglein 1

ECP

Eosinophil cationic protein

EDC

Epidermal differentiation complex

EDP

EoE diagnostic panel

EMR,

Electronic medical record

EMT

Epithelial-to-mesenchymal transition

EoE

Eosinophilic esophagitis

EPO

Eosinophil peroxidase

EPX

Eosinophil peroxidase

EST

Esophageal string test

FCERI

IgE Fragment crystallizable epsilon receptor 1

FLG

Filaggrin

GERD

Gastroesophageal reflux disease

GWAS

Genome-wide association studies

HPF

High-power field

IBD

Inflammatory bowel disease

Ig

Immunoglobulin

IL

Interleukin

ILCs

Innate lymphoid cells

iNKT

Invariant natural killer T cells

IVL

Involucrin

LDS

Loetyz-Dietz syndrome

MBP

Major basic protein

MIF

Macrophage migration inhibitory factor

MIP-1

Macrophage inflammatory protein 1

miRNAs

MicroRNAs

OIT

Oral immunotherapy

PAI-1

Plasminogen activator inhibitor-1

PGD2

Prostaglandin D2

PHTS

PTEN hamartoma tumor syndrome

POSTN

Periostin

PPI-REE

PPI-responsive esophageal eosinophilia

PPI

Proton pump inhibitor

PR

Pathogenesis-related

RANTES

Regulated on activation, normal T cells expressed and secreted

SAM

Severe dermatitis, multiple allergies, and metabolic wasting

SERPINs

Serine protease inhibitors

SPINKs

Serine protease inhibitors, Kazal type

SPRR

Small proline-rich repeat

SPT

Skin prick test

STAT

Signal transducer and activator of transcription

TGF-β

Transforming growth factor beta

TH

T helper type

TNF-α

Tumor necrosis factor-α

TPSAB1

Tryptase

TRAIL

TNF-related apoptosis-inducing ligand

Tregs

T regulatory cells

TSLP

Thymic stromal lymphopoietin

TTG

Tissue transglutaminase

TYK2

Tyrosine-protein kinase-2

UC

Ulcerative colitis

UPK1B

Uroplakin 1B

Notes

Funding

No funding was used in the creation of this manuscript.

Compliance with Ethical Standards

Conflicts of Interest

The author has no conflicts of interest.

Ethical Approval

The accepted principles of ethical and professional conduct were followed in the creation of this manuscript.

Informed Consent

No human subjects were a part of this manuscript.

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine, Division of ImmunologyUniversity of Iowa Hospitals and ClinicsIowa CityUSA

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