Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Nov 15, 2015; 6(4): 150-158
Published online Nov 15, 2015. doi: 10.4291/wjgp.v6.i4.150
Eosinophilic esophagitis: From pathophysiology to treatment
Alessandra D’Alessandro, Dario Esposito, Marcella Pesce, Rosario Cuomo, Giovanni Domenico De Palma, Giovanni Sarnelli
Alessandra D’Alessandro, Marcella Pesce, Rosario Cuomo, Giovanni Sarnelli, Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University, 80131 Naples, Italy
Dario Esposito, Giovanni Domenico De Palma, Department of Clinical Medicine and Surgery, Endoscopy Unit, Federico II University, 80131 Naples, Italy
Author contributions: D’Alessandro A, Esposito D and Pesce M reviewed literature data and wrote the manuscript; Cuomo R and De Palma GD participate to the critical revision of the manuscript; Sarnelli G designed, coordinated and revised the manuscript.
Conflict-of-interest statement: All the authors declare that they have no competing interests.
Open-Access: This article is an open-access article which 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: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Giovanni Sarnelli, MD, PhD, Department of Clinical Medicine and Surgery, Gastroenterology Unit, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy. sarnelli@unina.it
Telephone: +39-081-7464290 Fax: +39-081-7464290
Received: May 25, 2015
Peer-review started: May 28, 2015
First decision: July 27, 2015
Revised: July 30, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: November 15, 2015
Processing time: 175 Days and 13.6 Hours
Abstract

Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often require steroids; despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis, that require additional endoscopic treatments. This review summarizes the evidence on EoE pathophysiology and illustrates the safety and efficacy of the most recent medical and endoscopic treatments.

Keywords: Eosinophilic esophagitis; Eotaxin; Immune system; Proton pump inhibitors-responsive eosinophilia; Endoscopic dilation

Core tip: Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. The pathophysiology of this entity is still unclear, however the involvement of both genetic and immune factors have been suggested. In this review we summarize the evidence on EoE pathophysiology and illustrate the safety and efficacy of the most recent medical and endoscopic treatments.