Review article: The pathogenesis and management of eosinophilic oesophagitis

Abstract

Background: Eosinophilic oesophagitis is a clinicopathological disease affecting both children and adults that is characterized by symptoms of gastro-oesophageal reflux disease (feeding refusal, vomiting, heartburn, dysphagia and food impaction) and dense oesophageal eosinophilia both of which are unresponsive to proton pump inhibition. Aim: To present a review of the recent literature examining the pathogenesis and treatments of eosinophilic oesophagitis. Methods: We performed a PubMed search for eosinophilic oesophagitis, pathogenesis and treatments. Results: Translational and basic studies suggest that this disease is sparked by food or by aeroallergens. To date, effective treatments include systemic/ topical corticosteroids, specific food elimination or an elemental diet. While several studies identified oesophageal strictures as potential complications of unbridled eosinophilia, the natural history of the disease is still not certain. Recent studies suggest a role for interleukin-5 and eotaxin-3 in the pathogenesis of eosinophilic oesophagitis and suggest an impact of future targeted therapeutic agents. Conclusions: Eosinophilic oesophagitis represents a immune-mediated disease of undetermined pathogenesis. While many patients develop clinicopathological findings following ingestion of foods, others do not. Natural history studies will be critical to defining future treatment paradigms. © 2006 The Authors.