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Annals of Nutrition & Metabolism 2018Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically,... (Review)
Review
Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.
Topics: Colitis; Diagnosis, Differential; Enteritis; Eosinophilia; Eosinophilic Esophagitis; Food Intolerance; Gastritis; Gastrointestinal Tract; Humans; Inflammation
PubMed: 30783041
DOI: 10.1159/000493668 -
Digestive Diseases and Sciences Apr 2022Eosinophilic esophagitis (EoE) is a leading cause of food bolus impaction in children and adults. The mechanism of dysphagia in EoE, particularly non-obstructive... (Review)
Review
Eosinophilic esophagitis (EoE) is a leading cause of food bolus impaction in children and adults. The mechanism of dysphagia in EoE, particularly non-obstructive dysphagia, remains incompletely understood. While fibrostenotic processes appear to be critical in the development of dysphagia, somatosensory dysfunction and dysmotility also contribute. This review considers potential mechanisms of dysphagia and evaluates the utility of current and future treatment strategies in this context.
Topics: Adult; Causality; Child; Deglutition Disorders; Eosinophilic Esophagitis; Food; Humans
PubMed: 35230577
DOI: 10.1007/s10620-022-07419-6 -
Journal of Gastroenterology Jan 2019Eosinophilic esophagitis (EoE) is a food allergen-induced inflammatory disorder. EoE is increasingly recognized as a cause of swallowing dysfunction, food impaction and... (Review)
Review
Eosinophilic esophagitis (EoE) is a food allergen-induced inflammatory disorder. EoE is increasingly recognized as a cause of swallowing dysfunction, food impaction and esophageal stricture. Inflammation of the esophageal mucosa involves immune cell infiltrate, reactive epithelial changes and fibroblast activation, culminating in robust tissue remodeling toward esophageal fibrosis characterized by excess collagen deposition in the subepithelial lamina propria. Fibrosis contributes to a unique mechanical property of the EoE-affected esophagus that is substantially stiffer than the normal esophagus. There is a great need to better understand the processes behind esophageal fibrosis in order to foster improved diagnostic tools and novel therapeutics for EoE-related esophageal fibrosis. In this review, we discuss the role of esophageal inflammatory microenvironment that promotes esophageal fibrosis, with specific emphasis upon cytokines-mediated functional epithelial-stromal interplays, recruitment and activation of a variety of effector cells, and tissue stiffness. We then explore the current state of clinical methodologies to detect and treat the EoE-related esophageal stricture.
Topics: Allergens; Collagen; Cytokines; Eosinophilic Esophagitis; Esophageal Mucosa; Fibrosis; Food Hypersensitivity; Humans; Mucous Membrane
PubMed: 30101408
DOI: 10.1007/s00535-018-1498-3 -
Acta Gastro-enterologica Belgica 2023
Review
Topics: Humans; Eosinophilic Esophagitis; Esophagitis; Enteritis; Gastritis; Eosinophilia
PubMed: 38240548
DOI: 10.51821/86.4.12001 -
Expert Review of Clinical Immunology Apr 2019
Topics: Child; Eosinophilic Esophagitis; Humans; Hypersensitivity; Medical History Taking; Practice Guidelines as Topic; Risk Factors
PubMed: 30722709
DOI: 10.1080/1744666X.2019.1579643 -
Current Gastroenterology Reports Feb 2018The goal of this review is to present and summarize studies on endoscopic findings in eosinophilic esophagitis (EoE), at diagnosis and in response to treatment,... (Review)
Review
PURPOSE OF REVIEW
The goal of this review is to present and summarize studies on endoscopic findings in eosinophilic esophagitis (EoE), at diagnosis and in response to treatment, utilizing rigorous peer-reviewed literature in children wherever possible and to introduce a recently proposed standardized endoscopic evaluation system.
RECENT FINDINGS
Gold standard of diagnosis and assessment of response to therapy in EoE requires multiple endoscopies with biopsies for histology, which allows for observation of the esophageal mucosa. Typical endoscopic findings in patients with EoE include edema, exudate, furrowing, concentric rings, and strictures. Endoscopic findings have been broadly characterized into inflammatory features (edema, exudate, furrowing) and fibro-stenotic features (rings, stricture), in order to better reflect their underlying pathophysiology. Recent studies suggest strong correlations between endoscopic findings, through composite scoring systems, and histology, and therefore may be helpful as part of disease surveillance. The EoE Endoscopic Reference Score (EREFS) classification system was proposed in 2013 as an outcome metric for standardization in reporting endoscopic signs of EoE. Subsequent studies support utility of composite scoring, which utility has similarly been seen in pediatric treatment trials. Endoscopy in children provides insight into the natural history of EoE, with progressively more fibro-stenotic features occurring over time, giving an additional perspective into esophageal remodeling and response to treatment. Recognition of typical endoscopic findings at diagnosis and upon repeat endoscopy has allowed a clinician to monitor visual changes in esophageal mucosal health. Further studies to assess the role of composite scoring in disease management are needed.
Topics: Child; Eosinophilic Esophagitis; Esophageal Stenosis; Esophagoscopy; Humans; Severity of Illness Index
PubMed: 29492720
DOI: 10.1007/s11894-018-0607-z -
Journal of Gastroenterology Sep 2020The prevalence of eosinophilic esophagitis (EoE) has been increasing in Japan. Although the diagnosis of EoE is based on simple criteria that include the presence of... (Review)
Review
The prevalence of eosinophilic esophagitis (EoE) has been increasing in Japan. Although the diagnosis of EoE is based on simple criteria that include the presence of esophageal symptoms and esophageal eosinophilia on biopsies, there are several important issues associated with the diagnostic approach. Following an extensive literature search, the symptoms of 886 EoE cases in Japanese adults were analyzed and divided into three categories as follows: (1) typical symptoms, such as dysphagia (53%); (2) other upper GI symptoms (40%); and (3) no symptoms found during screening or medical examination, i.e., "asymptomatic esophageal eosinophilia" (19%). The diagnostic approach was reviewed according to these categories as well as according to the presence or absence of esophageal eosinophilia. The present manuscript describes the current therapeutic strategy of EoE and ultimately proposes a symptom-based diagnostic approach for EoE.
Topics: Adult; Biopsy; Deglutition Disorders; Eosinophilic Esophagitis; Humans; Japan; Mass Screening; Prevalence
PubMed: 32720208
DOI: 10.1007/s00535-020-01701-y -
Clinical Reviews in Allergy & Immunology Aug 2019Allergic eosinophilic esophagitis (EoE) is a chronic, allergen-mediated inflammatory disease of the esophagus, and the most common cause of prolonged dysphagia in... (Review)
Review
Allergic eosinophilic esophagitis (EoE) is a chronic, allergen-mediated inflammatory disease of the esophagus, and the most common cause of prolonged dysphagia in children and young adults in the developed world. While initially undistinguished from gastroesophageal reflux disease-associated esophageal eosinophilia, EoE is now recognized as a clinically distinct entity that shares fundamental inflammatory features of other allergic conditions and is similarly increasing in incidence and prevalence. The clinical and epidemiologic associations between EoE and other allergic manifestations are well established. In addition to exaggerated rates of atopic dermatitis, IgE-mediated food allergy, asthma, and allergic rhinitis in EoE patients, each of these allergic manifestations imparts individual and cumulative risk for subsequent EoE diagnosis. As such, EoE may be a member of the "allergic march"-the natural history of allergic manifestations during childhood. Several determinants likely contribute to the relationship between these conditions, including shared genetic, environmental, and immunologic factors. Herein, we present a comprehensive review of allergic comorbidity in EoE. We discuss areas of the genome associated with both EoE and other allergic diseases, including the well-studied variants encoding thymic stromal lymphopoietin and calpain 14, among other "atopic" regions. We summarize ways that environmental factors (such as microbiome-altering pressures and aeroallergen exposure) may predispose to multiple allergic conditions including EoE. Finally, we touch on some fundamental features of type 2 inflammation, and the resulting implications for the development of multiple allergic manifestations. We conclude with an analysis of the "type 2" biologics, and how mechanistic similarities between EoE and the other allergic manifestations have important implications for screening and treatment of the allergic patient.
Topics: Adolescent; Adult; Animals; Asthma; Child; Comorbidity; Dermatitis, Atopic; Eosinophilic Esophagitis; Food Hypersensitivity; Gastrointestinal Microbiome; Genetic Predisposition to Disease; Humans; Incidence; Inflammation; Mice; Molecular Targeted Therapy; Peptide Hydrolases; Prevalence; Rhinitis, Allergic; Young Adult
PubMed: 30903437
DOI: 10.1007/s12016-019-08733-0 -
Journal of Internal Medicine May 2017Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the oesophagus. Recognized as a distinct entity only two decades ago, the emergence of the disease... (Review)
Review
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the oesophagus. Recognized as a distinct entity only two decades ago, the emergence of the disease along with the availability of new technologies has rapidly opened new research avenues and outlined the main features of the pathogenesis of EoE. Yet, each advance in our understanding of the disease has raised new questions about the previous consensus. Currently, new subsets of the disease challenge our diagnostic criteria. For instance, it was believed that EoE did not respond to proton pump inhibitor (PPI) therapy; however, it has now been shown that a substantial proportion of EoE patients indeed respond to PPIs. In addition, a new subset of patients not even presenting eosinophil infiltrates in the oesophagus has also been described. Moreover, approaches for better understanding the heritability of the disease bring into question the dogma of predominant genetic involvement. Furthermore, the specificity and sensitivity of allergy testing for targeted food avoidance is highly controversial, and the production of specific antibodies in EoE now includes IgG4 in addition to IgE. In conclusion, EoE is perceived as 'a moving target' and the aim of this review was to summarize the current understanding of EoE pathogenesis.
Topics: Animals; Antigens; Biomarkers; Eosinophilic Esophagitis; Eosinophils; Esophageal Mucosa; Fibrosis; Food; Humans; Immunoglobulin E; Immunoglobulin G; Interleukin-13; Mice; Pain; Polymorphism, Genetic; Th2 Cells
PubMed: 28425585
DOI: 10.1111/joim.12568 -
Acta Medica Portuguesa Dec 2011Eosinophilic esophagitis (EE) is an inflammatory disease of the esophagus characterized by significant and isolated infiltration of the esophageal mucosa by eosinophils,... (Review)
Review
Eosinophilic esophagitis (EE) is an inflammatory disease of the esophagus characterized by significant and isolated infiltration of the esophageal mucosa by eosinophils, associated with clinical symptoms of esophageal dysfunction, affecting children and adults. It is an increasingly frequent cause of symptoms similar to gastroesophageal reflux disease but refractory to anti-acid therapeutic. It is commonly associated with food allergies or other atopic diseases. Since there are no symptoms, signs, serological biomarkers or endoscopic findings pathognomonic of EE, the diagnosis requires a high degree of suspicion; moreover, due to its chronic relapsing nature the potential to cause major esophageal structural changes, its early recognition and close cooperation between gastroenterologists and immunoallergologists is essential for the timely institution of appropriate therapy. The treatment is based on two main strategies: diet and / or pharmacotherapy, depending on the co-existence of sensitization to food allergens. It is our aim to review this issue, considering recent guidelines, as well as propose a diagnostic and therapeutic algorithm.
Topics: Algorithms; Eosinophilic Esophagitis; Humans
PubMed: 22863504
DOI: No ID Found