Abstract
Eosinophilic esophagitis (EoE) is a chronic allergic inflammatory disease that is triggered by food and/or environmental allergens and is characterized by a clinical and pathologic phenotype of progressive esophageal dysfunction due to tissue inflammation and fibrosis. EoE is suspected in patients with painful swallowing, among other symptoms, and is diagnosed by the presence of 15 or more eosinophils per high-power field in one or more of at least four esophageal biopsy specimens. The prevalence of EoE is increasing and has now reached rates similar to those of other chronic gastrointestinal disorders such as Crohn’s disease. In recent years, our understanding of the immunologic mechanisms underlying this condition has grown considerably. Thanks to new genetic, molecular, cellular, animal, and translational studies, we can now postulate a detailed pathway by which exposure to allergens results in a complex and coordinated type 2 inflammatory cascade that, if not intervened upon, can result in pain on swallowing, esophageal strictures, and food impaction. Here, we review the most recent research in this field to synthesize and summarize our current understanding of this complex and important disease.
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Abbreviations
- EoE:
-
Eosinophilic esophagitis
- Th:
-
T helper cell
- GERD:
-
Gastroesophageal reflux disease
- Ig:
-
Immunoglobulin
- CCL:
-
C-C motif ligand
- TGF-β:
-
Transforming growth factor beta
- TSLP:
-
Thymic stromal lymphopoietin
- IL:
-
Interleukin
- DSG:
-
Desmosomal cadherin desmoglein
- miRNA:
-
MicroRNA
- STAT:
-
Signal transducer and activator of transcription
- CD:
-
Cluster of differentiation
- PARP:
-
Poly(ADP-ribose) polymerase
- TNF-α:
-
Tumor necrosis factor alpha
- PGD:
-
Prostaglandin
- CRTH2:
-
Chemoattractant receptor expressed on Th2 cells
- ILCs:
-
Innate lymphoid cells
- iNKTs:
-
Invariant natural killer T cells
- APC:
-
Antigen-presenting cell
- MHC:
-
Major histocompatibility complex
- HR:
-
Histamine receptor
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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Acknowledgments
DAH is supported by a Resident Research Grant from the American Academy of Pediatrics. JMS is supported by the Stuart Starr Endowed Chair of Pediatrics, The Children’s Hospital of Philadelphia Eosinophilic Esophagitis Fund, a Food Allergy Research & Education, Inc. Clinical Network grant, and the Consortium of Eosinophilic Gastrointestinal Disease Researchers (U54 AI117804) which is part of the Rare Disease Clinical Research Network, an initiative of the National Center for Advancing Translational Sciences (NCATS) Office of Rare Disease Research, and is funded by NCATS and collaborating institute centers.
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Dr. Spergel reports grants from NIH, DBV Technology, Aimmune Therapeutics, FARE Clinical Network, and Stanford Food Allergy Center and is a consultant for Dannone. Dr. Hill reports grants from the AAP. The authors have no financial relationships or other conflicts of interest relevant to this article to disclose.
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Hill, D.A., Spergel, J.M. The Immunologic Mechanisms of Eosinophilic Esophagitis. Curr Allergy Asthma Rep 16, 9 (2016). https://doi.org/10.1007/s11882-015-0592-3
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DOI: https://doi.org/10.1007/s11882-015-0592-3