The spectrum of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a disorder of the esophagus where an aberrant immune response develops to food allergens ultimately leading to remodeling causing narrowing, decreased compliance and risk of food bolus impaction. The disease is increasing in incidence and prevalence with environmental exposures implied in disease development. It is a clinicopathologic disorder characterized by symptoms of esophageal dysfunction and eosinophil predominant inflammation with exclusion of other causes of esophageal eosinophilia. Symptoms can vary based on age and be minimized with compensatory behaviors, but adults commonly have dysphagia. Currently upper endoscopy with esophageal biopsies is required to confirm the diagnosis of EoE. There are classic endoscopic and histologic findings that help aid in diagnosis. Treatment options include proton pump inhibitors, swallowed topical corticosteroids, elimination diets, esophageal dilation, and a human monoclonal antibody dupilumab. Multiple advances continue to be made in the diagnosis and treatment of EoE, and the disease state is rapidly evolving.