| Over the past two decades, eosinophilic esophagitis (EoE) has transitioned from a little-known entity to a common cause of esophageal symptoms in both children and adults. The rising prevalence is attributed to both increased incidence and disease awareness. With the majority of large series coming from Western Europe and the United States, understanding the differences in the epidemiology of EoE between Asia and Western countries will provide valuable insights into the genetic and environmental factors responsible for EoE. The high rates of atopy in affected patients, translational research studies, and disease activation upon exposure to common food allergens support the concept that EoE is an allergic disorder. In addition, the identification of complex interactions with gastroesophageal reflux disease have led to refinement in the conceptual framework for diagnosis of EoE, specifically regarding the role of proton pump inhibition. The natural history of EoE is not well understood, although retrospective studies indicate progression to esophageal strictures in the majority of untreated adults. Topical steroids are a common and highly effective primary treatment strategy with newer formulations designed optimize esophageal delivery. Empiric dietary elimination of food allergens is also effective but hindered by necessity of repeated endoscopy for histologic confirmation of disease activity. Food allergy testing based on IgE response has limited utility in the identification of specific food triggers. Therefore, non-endoscopic techniques are being developed to assess esophageal inflammatory activity. Recent data demonstrating the efficacy of biologic therapies targeting allergic mediators substantiate the central importance of immunologic mechanisms of EoE and offer novel, novel, non-steroid therapeutic options. |
