Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2019; 25(32): 4598-4613
Published online Aug 28, 2019. doi: 10.3748/wjg.v25.i32.4598
Eosinophilic esophagitis: Current concepts in diagnosis and treatment
Andrés Gómez-Aldana, Mario Jaramillo-Santos, Andrés Delgado, Carlos Jaramillo, Adán Lúquez-Mindiola
Andrés Gómez-Aldana, Andrés Delgado, Departament of Internal Medicine, Section of Gastroenterology, Santa Fe Foundation of Bogotá (Fundación Santa Fe de Bogotá), Bogotá 220246, Colombia
Andrés Gómez-Aldana, University of Los Andes, Bogotá 111711, Colombia
Mario Jaramillo-Santos, Carlos Jaramillo, Department of Endoscopy, Caldas University, Manizales 275, Colombia
Mario Jaramillo-Santos, Department of Endoscopy, Surgeons’ Union SAS (Joint stock company) (Union de cirujanos SAS), Manizales 170001661, Colombia
Adán Lúquez-Mindiola, Department of Gastroenterology, Gut Médica, Bogotá 110221001, Colombia
Author contributions: The authors contributed equally to writing and revising the manuscript.
Conflict-of-interest statement: The authors have declared no conflicts of interest.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Andrés Gómez-Aldana, MD, Attending Doctor, Department of Endoscopy, Santa Fe Foundation of Bogotá (Fundación Santa Fe de Bogotá), Cra 7 # 117 15, Bogotá 220246, Colombia.
Telephone: +57-311-2139546
Received: May 13, 2019
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

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.

Keywords: Eosinophilic esophagitis, Corticoid, Esophageal stenosis, Diet, Dilation, Proton pump inhibitor

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.