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Eosinophilic oesophagitis: clinical presentation and pathogenesis
  1. Jonas Bystrom1,
  2. Nuala R O'Shea2,3
  1. 1Bone and Joint Research Unit, William Harvey Research Institute, Barts & the London, Queen Mary University of London, London, UK
  2. 2Department of Gastroenterology, University College Hospital, London, UK
  3. 3Division of Medicine, Centre for Molecular Medicine, Rayne Institute, University College London, London, UK
  1. Correspondence to Dr Jonas Bystrom, Bone and Joint Research Unit, William Harvey Research Institute, Barts & the London, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK; j.bystrom{at}qmul.ac.uk, Nuala O'Shea; nuala.o'shea@ucl.ac.uk

Abstract

Eosinophilic oesophagitis (EoE) is an inflammatory disorder of the oesophagus which has become increasingly recognised over recent years, although it remains underdiagnosed in many centres. It is characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field), and clinically with features of oesophageal dysfunction such a dysphagia, food impaction, and proton pump inhibitor (PPI) resistant dyspepsia. Fibrosis and oesophageal remodelling may occur and lead to oesophageal strictures. An allergic predisposition is common in the EoE population, which appears to be primarily food antigen driven in children and aeroallergen driven in adults. Evidence suggests that the pathogenesis of EoE is due to a dysregulated immunological response to an environmental allergen, resulting in a T helper type 2 (Th2) inflammatory disease and remodelling of the oesophagus in genetically susceptible individuals. Allergen elimination and anti-inflammatory therapy with corticosteroids are currently the mainstay of treatment; however, an increasing number of studies are now focused on targeting different stages in the disease pathogenesis. A greater understanding of the underlying mechanisms resulting in EoE will allow us to improve the therapeutic options available.

  • HISTOPATHOLOGY
  • IMMUNOLOGY
  • PUBLIC HEALTH

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