Eosinophilic Esophagitis

Eosinophilic esophagitis (EOE) is a chronic inflammatory disorder propagated by interleukin-5 (IL-5); it is unrelated to gastroesophageal reflux disease (GERD). Formerly a rare disease initially described in children and young men, EOE has been diagnosed more frequently in the past 10 years. According to current estimates, EOE has an annual incidence of 10 per 100,000 in children and teenagers and 30 per 100,000 in the adult population. EOE has a male:female ratio of 3 : 1. It leads to structural esophageal alterations but does not affect the nutritional state and has no malignant potential. EOE is distinguished by the presence of eosinophilic infiltration of the esophageal mucosa of at least 15 eosinophils per high-power field (hpf) in a patient without a previously identified cause of eosinophilia.

The pathogenesis of EOE is not completely understood, but clinical evidence and basic science support that it is an immune-mediated disease initiated by allergens that are inhaled or consumed. Exposure to the allergens with resultant sensitization may be a genetically acquired predisposition. The foods that are most allergenic include corn, chicken, wheat, beef, soy, eggs, and milk. The pathologic process may entail the activation of eosinophils, mast cells, and lymphocytes with the resultant release of molecules that trigger the onset of symptoms.