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Therapeutic concepts in adult and paediatric eosinophilic oesophagitis

Nature Reviews Gastroenterology & Hepatology volume 9, pages 697–704 (2012)Cite this article

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Abstract

Eosinophilic oesophagitis (EoE) was first described in the early 1990s. Although initially reported to be a rare entity, EoE has rapidly become a regularly diagnosed disease with a prevalence of approximately 1 in 2,000 individuals in the USA and Europe. The disease is characterized by a combination of oesophageal dysfunction and predominant eosinophilic infiltration of the oesophageal tissue. At diagnosis, other diseases that can be associated with oesophageal eosinophilic infiltration must be ruled out. Children with EoE present with a wide variety of symptoms, whereas adults mostly present with dysphagia for solid food and chest pain. Histologic features of EoE resemble those of T-helper type 2 inflammation. Endoscopy should be carried out to establish the diagnosis, but endoscopic abnormalities are not pathognomonic for EoE and the examination might not show histologic abnormality. Treatment modalities for EoE include drugs (corticosteroids, PPIs, antiallergic and biologic agents), hypoallergenic diets and oesophageal dilatation for strictures that are unresponsive to medical therapy. Unresolved eosinophilic inflammation leads to the formation of oesophageal strictures, which probably increase the risk of food bolus impactions. To date, long-term strategies for the therapeutic management of this chronic inflammatory disease remain poorly defined.

Key Points

  • The incidence and prevalence of eosinophilic oesophagitis (EoE) is increasing in Western countries

  • A combination of clinical, endoscopic and histologic findings are used to diagnose EoE

  • Patients with EoE should be treated to improve quality of life, to reduce the risk of oesophageal injury associated with food impaction and to prevent or reduce oesophageal remodelling

  • Treatment modalities include drugs (such as corticosteroids, antiallergic agents, immunomodulators and biologic agents), food elimination diets and oesophageal dilatation

  • Treatment with corticosteroids consists of an induction and maintenance phase

  • Long-term management approaches for EoE (>1 year) remain poorly defined

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Figure 1: Oesophageal squamous epithelium abnormalities in eosinophilic oesophagitis.
Figure 2: Endoscopy for EoE.

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Acknowledgements

The authors are grateful to Ekaterina Safroneeva, PhD, for editorial assistance. The authors' research is supported by a grant from the Swiss National Science Foundation to AS and AMS (Grant No. 32003B_135665/1).

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Authors and Affiliations

  1. Chairman Swiss EoE Research Network, Roemerstrasse 7, 4600, Olten, Switzerland

    Alex Straumann

  2. Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland

    Alain M. Schoepfer

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Straumann, A., Schoepfer, A. Therapeutic concepts in adult and paediatric eosinophilic oesophagitis. Nat Rev Gastroenterol Hepatol 9, 697–704 (2012). https://doi.org/10.1038/nrgastro.2012.182

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