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Pathophysiology of Eosinophilic Esophagitis

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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.

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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

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  1. Department of Internal Medicine, Division of Immunology, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52246, USA

    Benjamin P. Davis

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Davis, B.P. Pathophysiology of Eosinophilic Esophagitis. Clinic Rev Allerg Immunol 55, 19–42 (2018). https://doi.org/10.1007/s12016-017-8665-9

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