Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4598
Peer-review started: May 13, 2019
First decision: May 30, 2019
Revised: July 13, 2019
Accepted: July 19, 2019
Article in press: July 19, 2019
Published online: August 28, 2019
Processing time: 110 Days and 9.2 Hours
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.
Core tip: Eosinophilic esophagitis affects both pediatric and adult patients. It causes symptoms that are initially attributed to gastroesophageal reflux, for which treatment with proton pump inhibitors is prescribed, with limited response. The objective of this review is to define the fundamental aspects of the development of this disease and the complementary and beneficial role of proton pump inhibitors without neglecting the need for diets that involve spaced withdrawal of certain foods.