Abstract
Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3-20.e6 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 128 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jul 2011 |
Funding
Disclosure of Significant Relationships with Relevant Commercial Companies/Organizations: C. A. Liacouras is a consultant for Cephalon, a speaker for Nutricia and Abbott, and a physician member of the American Partnership for Eosinophilic Disorders. G. T. Furuta is a consultant for Meritage and Sunovion and has received research support from the National Institutes of Health and the American Partnership for Eosinophilic Disorders. I. Hirano is a consultant for Meritage Pharma. D. Atkins is a consultant for Sunovion and has received research support from AstraZeneca. P. A. Bonis has received research support from TIGER. A. W. Burks is a consultant for ActoGeniX NV, Intelliject, McNeil Nutritionals, Novartis, Pfizer, and Schering-Plough; is a minority stockholder for Allertein and MastCell, Inc; is on the Dannon Co Probiotics Advisory Board; is on the Nutricia Expert Panel; has received research support from the National Institutes of Health, the Food Allergy and Anaphylaxis Network (FAAN), and the Wallace Research Foundation; has provided legal consultation/expert witness testimony on the topic of food allergy; is on the FAAN medical Board of Directors; is an American College of Allergy, Asthma & Immunology (ACAAI) Dermatological Allergy Committee Member; is a National Institutes of Health (NIH) HAI Study Section Member; is on the US Food and Drug Administration (FDA) Reviewer Board; and is on the Journal of Allergy and Clinical Immunology (JACI) Editorial Board. M. H. Collins is a consultant for Sunovion, Meritage Pharma, and Cephalon and is a member of the American Partnership for Eosinophilic Disorders (APFED) medical advisory panel. E. S. Dellon has received research support from AstraZeneca, the American College of Gastroenterology, and the NIH/UNC. R. Dohil is a stockholder in Meritage Pharmaceuticals. G. W. Falk is a consultant for Eurand. N. Gonsalves has received research support from the Campaign Urging Research for Eosinophilic Disease (CURED) and David & Denise Bunning. S. K. Gupta is a speaker for Abbott and a consultant for Baxter and Meritage. H. A. Sampson is a consultant for Allertein Therapeutics, LLC; has received research support from the Food Allergy Initiative and the National Institute for Allergy and Infectious Diseases (NIAID)/NIH; is a consultant and scientific advisor for the Food Allergy Initiative; is a medical advisor for the FAAN; is a scientific advisor for the University of Nebraska–Food Allergy Research and Resource Program (FARRP); and is 45% owner of Herbal Springs, LLC. A. Schoepfer has received research support from AstraZeneca, GlaxoSmithKline, and Dr Falk Ah. N. J. Shaheen is a consultant for AstraZeneca. S. H. Sicherer is a consultant for the Food Allergy Initiative and has received research support from the NIAID/NIH. S. Spechler is a consultant for Torax Medical, Xenoport, and Ironwood Pharmaceuticals and has received research support from Takeda Pharmaceuticals. J. M. Spergel is on the DBV Scientific board of directors; has received research support from Cephalon, APFED, and the NIH/DOD; and is on the APFED Medial Advisory Board and the American Academy of Allergy, Asthma & Immunology (AAAAI)'s Annual Meeting Program Committee. B. K. Wershil is a speaker for Prometheus Pharmaceutical, Inc; has received research support from Meritage; and is Secretary/Treasurer for Children's Digestive Health Foundation. M. E. Rothenberg has equity interest to reslizumab in Cephalon; is a consultant for Array Biopharma, Biocrystal Pharmaceuticals, and Endo Pharmaceuticals; has received research support from the National Institutes of Health, the FAAN, and the Hana Foundation; and is on the American Partnership for Eosinophilic Disorders Medical Advisory Board and the International Eosinophilic Society Executive Council. S. S. Aceves is coinventor of the Meritage Pharma Oral Viscous Budesonide and is chair of the medical advisory panel of APFED. The rest of the authors have declared that they have no conflict of interest.
Keywords
- Eosinophils
- eosinophilic
- esophageal
- esophagitis
- food allergy
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
