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Basics
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, inflammatory esophageal disease characterized clinically by dysphagia, chest pain, and food impaction, and histologically by eosinophilic infiltration of mucosa throughout the esophagus (1)[A].
Epidemiology
All ages, most common in 20s–30s; Male > Female, 3:1 in both children and adults
Incidence- Incidence in general population is 0.03% (2)[A].
- Incidence in those with gastroesophageal reflux disease (GERD)/dysphagia symptoms: 2.8% (2)[A]
Prevalence
Gradually increasing, perhaps due to better case finding, understanding of EoE in multiple clinical guises; 4–6/100,000
Risk Factors
- >50% with EoE have personal history of atopy/allergic disorders, such as asthma, hay fever, or eczema (1)[A].
- High rate of associated food antigen allergies/anaphylaxis
- EoE susceptibility may be caused by polymorphisms in thymic stromal lymphopoietin protein (TSLP) (1)[A].
- Potential new subphenotype of EoE (may also overlap with GERD): Proton pump inhibitor (PPI)-responsive esophageal eosinophilia, where PPIs may act to decrease the inflammatory response in EoE (1)[A]
Pathophysiology
- Growing body of evidence that EoE is an abnormal immune/antigenic process
- Like eczema and asthma, it seems to be T-helper 2 (TH2) lymphocyte-driven.
- Although not well understood, the pathophysiology of EoE is postulated to be due to increased recruitment and activation of eosinophils in the esophagus. Eosinophil chemoattractants include eotaxin-3, IL-5, and IL-13.
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