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Barrier Dysfunction in Eosinophilic Esophagitis

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Abstract

Purpose of Review

Compelling evidence over the past decade supports the central role of epithelial barrier dysfunction in the pathophysiology of eosinophilic esophagitis (EoE). The purpose of this review is to summarize the genetic, environmental, and immunologic factors driving epithelial barrier dysfunction, and how this impaired barrier can further promote the inflammatory response in EoE.

Recent Findings

Common environmental exposures, such as detergents, may have a direct impact on the esophageal epithelial barrier. In addition, the effects of IL-13 on barrier dysfunction may be reduced by 17β-estradiol, Vitamin D, and the short chain fatty acids butyrate and propionate, suggesting novel therapeutic targets.

Summary

There are many genetic, environmental, and immunologic factors that contribute to epithelial barrier dysfunction in EoE. This leads to further skewing of the immune response to a “Th2” phenotype, alterations in the esophageal microbiome, and penetration of relevant antigens into the esophageal mucosa, which are central to the pathophysiology of EoE.

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Funding

This work was funded by the NIH through the following grants: 1R01AI175232 (ECM).

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Authors and Affiliations

  1. Division of Allergy and Immunology, University of Virginia School of Medicine, PO Box 801355, Charlottesville, VA, 22908, USA

    Emily C. McGowan & Roopesh Singh

  2. Division of Digestive and Liver Disease, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA

    David A. Katzka

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  1. Emily C. McGowan
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  2. Roopesh Singh
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ECM, RS and DK served as the primary authors. RS prepared figures 1 and 2. All authors reviewed the manuscript and approved the final draft submitted.

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Correspondence to Emily C. McGowan.

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ECM receives grant support from the NIH/NIAID and consulting fees from Regeneron. DAK received an honorarium from Sanofi and Medtronic.

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McGowan, E.C., Singh, R. & Katzka, D.A. Barrier Dysfunction in Eosinophilic Esophagitis. Curr Gastroenterol Rep 25, 380–389 (2023). https://doi.org/10.1007/s11894-023-00904-6

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