Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2016; 7(1): 66-77
Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.66
Eosinophilic esophagitis: New insights in pathogenesis and therapy
Michele Pier Luca Guarino, Michele Cicala, Jose Behar
Michele Pier Luca Guarino, Michele Cicala, Unit of Digestive Disease, Campus Bio Medico University of Rome, 00128 Rome, Italy
Jose Behar, Brown University Medical School, Providence, RI 02912, United States
Author contributions: All the authors contributed equally to the manuscript, drafting the article and revising it critically for important intellectual content; all approve the final version for publication.
Conflict-of-interest statement: The authors have nothing to disclose.
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: Michele Cicala, MD, PhD, Unit of Digestive Disease, Campus Bio Medico University of Rome, Via Alvaro del Portillo 200, 00128 Rome, Italy. m.cicala@unicampus.it
Telephone: +39-06-22541560 Fax: +39-06-22541520
Received: June 12, 2015
Peer-review started: June 14, 2015
First decision: August 5, 2015
Revised: November 24, 2015
Accepted: December 1, 2015
Article in press: December 2, 2015
Published online: February 6, 2016
Abstract

Eosinophilic esophagitis (EoE) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus that may persist despite treatment with proton pump inhibitors. This eosinophilic infiltration is usually absent in the stomach, small intestine and colon, although there are a number of reports of patients with a multi-organ involvement. EoE is associated with abnormalities involving TH2-dependent immunity, with multiple environmental factors strongly contributing to disease expression. The layer of the esophagus affected by the eosinophilic infiltration causes the specific symptoms. Esophageal involvement results mostly in dysphagia for solids that can be severe enough to cause recurrent esophageal obstruction with typical endoscopic features suggesting esophageal remodeling and pathological changes of eosinophilic infiltration of the mucosa, sub-epithelial fibrosis and muscle hypertrophy. This disease is frequently associated with other allergic conditions such as allergic asthma, allergic dermatitis and eosinophilia. The treatment of patients with EoE depends on the severity of the symptoms and of the inflammatory process as well as to their response to a gradual step-up treatment. The first line of treatment consists of steroid containing local inhalers. If unresponsive they are then treated with oral steroids. Intravenous interleukin blockers seem to have a consistent positive therapeutic effect.

Keywords: Eosinophilic esophagitis, Gastro-esophageal reflux disease, Esophagus, Esophagitis, Eosinophilia, Cytokines

Core tip: Eosinophilic esophagitis is a clinico-pathological entity characterized by esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus. Our manuscript provides a deep description of the disease showing that many efforts have been made in the last decades in understanding its pathogenesis paving the way to new therapeutic targets which are reviewed in the manuscript. For these reasons, the story would not appear to end herewith but deserves further attention and investigation.