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Mechanisms and clinical management of eosinophilic oesophagitis: an overview

Nature Reviews Gastroenterology & Hepatology volume 20, pages 101–119 (2023)Cite this article

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Abstract

Since the first description of eosinophilic oesophagitis (EoE) less than three decades ago, we have observed a striking increase in the number of patients diagnosed with EoE and the understanding of its clinical and immunopathogenic background. Nonetheless, a plethora of open questions await elucidation. In this Review, we discuss the current state of knowledge regarding the underlying mechanisms, particularly environmental factors and their interaction with genetic susceptibility. Subsequently, we discuss how to translate these factors into the diagnostic and therapeutic management of this chronic, immune-mediated disorder. Finally, we dissect the still long list of unmet needs, such as reasons for and handling refractory EoE and atypical clinical presentations. These open questions can guide us through future research steps and potentially foster reconsideration of the diagnostic guidelines of EoE.

Key points

  • Eosinophilic oesophagitis (EoE) is a T helper 2 (TH2)-mediated inflammation of the oesophagus with a genetic component which, usually, is neither necessary nor sufficient to promote EoE.

  • EoE represents a T cell-mediated food allergy.

  • A diagnosis of EoE is based on a combination of clinical, endoscopic and histological findings.

  • The detection of relevant eosinophilia in the oesophageal tissue is a cornerstone in diagnosing classic EoE, but at least three EoE variants with identical clinical manifestations without marked eosinophilia exist.

  • Anti-inflammatory treatment modalities include swallowed topically acting corticosteroids, proton pump inhibitors, biologics and food elimination diets, whereas dilation only has an effect on symptoms.

  • Based on our current understanding, EoE is a chronic and incurable disease requiring long-term anti-inflammatory treatment.

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Fig. 1: Overview of the pathogenesis of eosinophilic oesophagitis.
Fig. 2: Endoscopic features of eosinophilic oesophagitis.
Fig. 3: Diagnostic and therapeutic algorithm.

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Biedermann, L., Straumann, A. Mechanisms and clinical management of eosinophilic oesophagitis: an overview. Nat Rev Gastroenterol Hepatol 20, 101–119 (2023). https://doi.org/10.1038/s41575-022-00691-x

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