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.
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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
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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
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Cianferoni, A., Spergel, J. Eosinophilic Esophagitis: A Comprehensive Review. Clinic Rev Allerg Immunol 50, 159–174 (2016). https://doi.org/10.1007/s12016-015-8501-z
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DOI: https://doi.org/10.1007/s12016-015-8501-z