Understanding eosinophilic esophagitis: the cellular and molecular mechanisms of an emerging disease

Abstract

Eosinophilic esophagitis (EoE) has been increasingly recognized as a unique clinicopathological entity over the past two decades. In this short time, the mechanisms of a complex disease have begun to emerge. Patient studies suggest that EoE is an immunologic disease related to atopy. At the cellular level, eosinophils, mast cells, and B and T lymphocytes are increased in the esophageal mucosa in a patchy distribution throughout the length of the esophagus. Laboratory investigations have implicated aeroallergens, food allergens, and a unique T helper type 2 cytokine profile. EoE appears to be an antigen-driven hypersensitivity reaction characterized by a mixed IgE-dependent/delayed-type reaction and a distinct cascade of cytokines and growth factors. The causative events that lead to EoE in humans remain unknown.

Value of microarray allergen assay in the management of eosinophilic oesophagitis

“…10,15 Provocation techniques with foods are very hard in EoE, especially in multi-sensitised patients. 14,15 Recently it has become possible to measure IgE antibodies to specific allergen molecules, using a method called component resolved diagnostics (CRD). For aeroallergens, CRD has shown a good correlation with classic IgE assays in multi-sensitised patients.…”

“…13 Although the international consensus document for diagnosis or therapeutic management of EoE 1 establishes demonstration of disease recrudescence after food reintroduction, provocation techniques with foods are very hard in EoE, especially in multi-sensitised patients. 14,15 According to consensus guidelines for managing EoE in children and adults, allergy test results by themselves cannot be used to make a diagnosis of EoE food triggers, which only can be achieved after documented disease remission upon food restriction and recrudescence when reintroduction. As a result, restrictions in diets should not be recommended to EoE patients exclusively on the basis of positive test results.…”

Emerging drugs for eosinophilic esophagitis

“…Biologic agents represent a promising class of emerging therapies that target specific pathways believed to be critical to the pathogenesis of EoE, especially the Th2 pathway [37]. The Th2 pathway is mediated by three key cytokines: interleukin (IL)-4, IL-5 and IL-13 [37].…”

Diagnosis and treatment of benign inflammatory esophageal diseases

“…In contrast, EoE represents a chronic allergen-based immunologic disease that is characterized by remodeling of the esophageal wall caused by infiltrating immune cells in a T helper cells 2 type like reaction [6]. A large Chinese epidemiological study of randomly selected individuals noticed that esophageal eosinophilia was present in 6.6 %, whereas EoE was diagnosed in 0.4 % [7].…”