Skip to main content

Advertisement

SpringerLink
Log in

Eosinophilic esophagitis: Concepts, controversies, and evidence

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Eosinophilic esophagitis has become a prominent chronic esophageal disorder in clinical pediatric and adult gastroenterology. Its manifestations are protean in childhood, but dysphagia predominates the clinical presentation in adults. Adverse immune responsiveness to dietary antigens underlies most cases, as is reflected in clinical and histologic remission with appropriate diet management in the majority, although an understanding of the mechanisms underlying the inflammatory process remains incomplete. Intense investigations to explain the underpinnings of the disorder and to discover effective therapy are ongoing.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Kelly KJ, Lazenby AJ, Rowe PC, et al.: Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995, 109:1503–1512.

    Article  PubMed  CAS  Google Scholar 

  2. Noel RJ, Putnam PE, Rothenberg ME.: Eosinophilic esophagitis. N Engl J Med 2004, 351:940–941.

    Article  PubMed  CAS  Google Scholar 

  3. Cherian S, Smith NM, Forbes DA.: Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child 2006, 91:1000–1004.

    Article  PubMed  CAS  Google Scholar 

  4. Kapel RC, Miller JK, Torres C, et al.: Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology 2008, 134:1316–1321.

    Article  PubMed  Google Scholar 

  5. Furuta GT, Liacouras CA, Collins MH, et al.: Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. First International Gastrointestinal Eosinophil Research Symposium (FIGERS) Subcommittees. Gastroenterology 2007, 133:1342–1363.

    Article  PubMed  CAS  Google Scholar 

  6. Teitelbaum JE, Fox VL, Twarog FJ, et al.: Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002, 122:1216–1225.

    Article  PubMed  CAS  Google Scholar 

  7. Ngo P, Furuta GT, Antonioli DA, Fox VL: Eosinophils in the esophagus-peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol 2006, 101:1666–1670.

    Article  PubMed  Google Scholar 

  8. Blanchard C, Wang N, Stringer KF, et al.: Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest 2006, 116:536–547.

    Article  PubMed  CAS  Google Scholar 

  9. Blanchard C, Mingler MK, Vicario M, et al.: IL-13 involvement in eosinophilic esophagitis: transcriptome analysis and reversibility with glucocorticoids. J Allergy Clin Immunol 2007, 120:1292–1300.

    Article  PubMed  CAS  Google Scholar 

  10. Fox VL: Eosinophilic esophagitis: endoscopic findings. Gastrointest Endosc Clin N Am 2008, 18:45–57.

    Article  PubMed  Google Scholar 

  11. Liacouras CA, Spergel JM, Ruchelli E, et al.: Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005, 3:1198–1206.

    Article  PubMed  Google Scholar 

  12. Gonsalves N, Policarpio-Nicolas M, Zhang Q, et al.: Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 2006, 64:313–319.

    Article  PubMed  Google Scholar 

  13. Khan S, Orenstein SR, Di Lorenzo C, et al.: Eosinophilic esophagitis: strictures, impactions, dysphagia. Dig Dis Sci 2003, 48:22–29.

    Article  PubMed  Google Scholar 

  14. Straumann A, Bussmann C, Zuber M, et al.: Eosinophilic esophagitis: analysis of food impaction and perforation in 251 adolescent and adult patients. Clin Gastroenterol Hepatol 2008, 6:598–600.

    Article  PubMed  Google Scholar 

  15. Cohen MS, Kaufman AB, Palazzo JP, et al.: An audit of endoscopic complications in adult eosinophilic esophagitis. Clin Gastroenterol Hepatol 2007, 5:1149–1153.

    Article  PubMed  Google Scholar 

  16. Orenstein SR, Shalaby TM, Di Lorenzo C, et al.: The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol 2000, 95:1422–1430. Erratum in: Am J Gastroenterol 2001, 96:2290.

    Article  PubMed  CAS  Google Scholar 

  17. Assa’ad AH, Putnam PE, Collins MH, et al.: Pediatric patients with eosinophilic esophagitis: an 8-year follow-up. J Allergy Clin Immunol 2007, 119:731–738.

    Article  PubMed  Google Scholar 

  18. Markowitz JE, Spergel JM, Ruchelli E, et al.: Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol 2003, 98:777–782.

    Article  PubMed  CAS  Google Scholar 

  19. Spergel JM, Brown-Whitehorn T, Beausoleil JL, et al.: Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol 2007, 119:509–511.

    Article  PubMed  Google Scholar 

  20. Spergel JM, Andrews T, Brown-Whitehorn TF, et al.: Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 2005, 95:336–343.

    Article  PubMed  Google Scholar 

  21. Konikoff MR, Blanchard C, Kirby C, et al.: Potential of blood eosinophils, eosinophil-derived neurotoxin, and eotaxin-3 as biomarkers of eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006, 4:1328–1336.

    Article  PubMed  CAS  Google Scholar 

  22. Gupta SK, Fitzgerald JF, Kondratyuk T, et al.: Cytokine expression in normal and inflamed esophageal mucosa: a study into the pathogenesis of allergic eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2006, 42:22–26.

    Article  PubMed  CAS  Google Scholar 

  23. Kagalwalla AF, Sentongo TA, Ritz S, et al.: Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006, 4:1097–1102.

    Article  PubMed  Google Scholar 

  24. Konikoff MR, Noel RJ, Blanchard C, et al.: A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology 2006, 131:1381–1391.

    Article  PubMed  CAS  Google Scholar 

  25. Noel RJ, Putnam PE, Collins MH, et al.: Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2004, 2:568–575.

    Article  PubMed  CAS  Google Scholar 

  26. Schaefer ET, Fitzgerald JF, Molleston JP, et al.: Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children. Clin Gastroenterol Hepatol 2008, 6:165–173.

    Article  PubMed  CAS  Google Scholar 

  27. Aceves SS, Bastian JF, Newbury RO, Dohil R: Oral viscous budesonide: a potential new therapy for eosinophilic esophagitis in children. Am J Gastroenterol. 2007, 102:2271–2279.

    Article  PubMed  CAS  Google Scholar 

  28. Faubion WA Jr, Perrault J, Burgart LJ, et al.: Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr. 1998, 27:90–93.

    Article  PubMed  Google Scholar 

  29. Stein ML, Collins MH, Villanueva JM, et al.: Anti-IL-5 (mepolizumab) therapy for eosinophilic esophagitis. J Allergy Clin Immunol 2006, 118:1312–1319.

    Article  PubMed  CAS  Google Scholar 

  30. Blanchard C, Mishra A, Saito-Akei H, et al.: Inhibition of human interleukin-13-induced respiratory and oesophageal inflammation by anti-human-interleukin-13 antibody (CAT-354). Clin Exp Allergy 2005, 35:1096–1103.

    Article  PubMed  CAS  Google Scholar 

  31. Aceves SS, Newbury RO, Dohil R, et al.: Esophageal remodeling in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 2007, 119:206–212.

    Article  PubMed  CAS  Google Scholar 

  32. Straumann A, Spichtin HP, Grize L, et al.: Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 2003, 125:1660–1669.

    Article  PubMed  Google Scholar 

  33. Mishra A, Wang M, Pemmaraju VR, et al.: Esophageal remodeling develops as a consequence of tissue specific IL-5-induced eosinophilia. Gastroenterology 2008, 134:204–214.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology, Hepatology, and Nutrition, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati Center for Eosinophilic Disorders, 3333 Burnet Avenue, ML 2010, Cincinnati, OH, 45229, USA

    Philip E. Putnam

Authors
  1. Philip E. Putnam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc E. Rothenberg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip E. Putnam.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Putnam, P.E., Rothenberg, M.E. Eosinophilic esophagitis: Concepts, controversies, and evidence. Curr Gastroenterol Rep 11, 220–225 (2009). https://doi.org/10.1007/s11894-009-0034-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-009-0034-2

Keywords

Search

Navigation