The Role of Environmental Exposures in the Etiology of Eosinophilic Esophagitis

Green, Daniel; Cotton, Cary C.; Dellon, Evan S.

doi:10.1016/j.mayocp.2015.07.015

Cited by 19 publications

(6 citation statements)

References 54 publications

(82 reference statements)

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“…There is intense interest in learning why the incidence and prevalence of EoE are increasing. 13, 88–90 Although some genetic factors have been associated with EoE, 15 the rapid trends in EoE incidence indicate a role for environmental factors in disease risk. 14 In a study of a large administrative database in the United States, prevalence increased steadily with age, to a peak value in individuals 30–44 years old.…”

Section: Epidemiologymentioning

confidence: 99%

Epidemiology and Natural History of Eosinophilic Esophagitis

2018

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Eosinophilic esophagitis (EoE) has emerged over the past 2 decades as a major cause of upper gastrointestinal morbidity. Over this time, the epidemiology of EoE has also rapidly evolved. EoE has transformed from a rare case-reportable condition to disease that is commonly encountered in the gastroenterology clinic, hospital emergency room, and endoscopy suite. The incidence and prevalence are increasing at rates that outpace increased disease recognition. Current incidence estimates range from 5 to 10 cases per 100,000, and current prevalence estimates range from 0.5 to 1 case per 1000. We review the data and potential reasons behind this increase, examine risk factors, and identify important areas for research into disease etiology. The article also discusses the progression of EoE from an inflammatory to fibrostenotic phenotype. An accurate view of the natural history of EoE is central to discussions with patients regarding disease prognosis and decisions about long-term use of medical, endoscopic, and diet therapies. Progressive remodelling appears to be gradual, but not universal, and the duration of untreated disease is the best predictor of stricture risk. Ultimately, prospective, long-term outcome studies focusing on multiple aspects of disease activity are needed to fully understand the natural history of EoE.

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Section: Epidemiologymentioning

confidence: 99%

Epidemiology and Natural History of Eosinophilic Esophagitis

2018

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“…There are several factors that are thought to contribute to the increase in the incidence of EoE in recent years[9]: (1) The hypothesis of hygiene and bacterial dysbiosis, that is, that modern life and hygiene conditions have decreased the incidence of infections, resulting in less bacterial exposure and thus altering the body’s microbiota and epithelial permeability[10]; (2) Environmental factors, such as changes in aeroallergen air conditions and concentrations of airborne pollen[11,12] and/or genetic and chemical modifications used in the cultivation, processing, and packaging of food[9]; (3) Decreased frequency of infection by Helicobacter pylori (H. pylori) in certain countries (it has been found that this bacterium increases Th1 and Th17 populations, downregulating Th2)[13]; (4) Gastroesophageal reflux disease (GERD), an entity that leads to the injury of intraepithelial junctions, causing greater allergen permeability in the esophageal epithelium as measured by mucosal impedance[14,15]; and (5) The use of acid-suppressive drugs, which is paradoxical, given that proton pump inhibitors (PPIs) exert an anti-inflammatory effect by blocking eotaxin secretion[16] and inhibiting acid secretion, thereby reducing activation of digestive enzymes such that the antigens in food do not degrade and the digestive system is protected from the immune response mediated by these proteins[17].…”

Section: Environmental Factorsmentioning

confidence: 99%

Eosinophilic esophagitis: Current concepts in diagnosis and treatment

Aldana¹,

Jaramillo-Santos²,

Delgado³

et al. 2019

WJG

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Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. Its symptoms, which include heartburn, regurgitation, and esophageal stenosis (with dysphagia being more frequent in eosinophilic esophagitis in young adults and children), are similar to those of gastroesophageal reflux disease, causing delays in diagnosis and treatment. Although endoscopic findings such as furrows, esophageal mucosa trachealization, and whitish exudates may suggest its presence, this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia (parasitic infections, hypereosinophilic syndrome, inflammatory bowel disease, among others) for which treatment could be initiated. Currently, the 3 “D”s (“Drugs, Diet, and Dilation”) are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. Herein, the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed, in addition to evidence for the various treatments.

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“…Thus, studies such as that of Moawad et al [7] and Fahey et al [8] show that there may be a correlation between the incidence of EoE and some aeroallergens, although to date it has been impossible to distinguish which ones may be responsible. A recent systematic review recognizes that seasonal, geographical, and climate-based differences in disease prevalence could be due to multiple environmental exposures, although the exact mediators of this process remain elusive [19].…”

Section: Resultsmentioning

confidence: 99%