Eosinophilic esophagitis. N Engl J Med

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
New England Journal of Medicine (Impact Factor: 55.87). 09/2004; 351(9):940-1. DOI: 10.1056/NEJM200408263510924
Source: PubMed

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    • "A betegség leggyakrabban gyermekkorban vagy fi atal felnőttkorban jelentkezik [2]. Noel és mtsai 2000– 2003 között az ohiói gyermekpopulációban vizsgálva az EoE-prevalenciát 4/100 000, az EoE-incidenciát 0,9– 1,3/100 000-nek találták [3]. Egy 16 éven át tartó svájci tanulmány hasonló prevalenciát (2/100 000) és incidenciát (1,4/100 000) fi gyelt meg felnőtt betegek körében [4]. "
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    ABSTRACT: Eosinophilic esophagitis is considered to be a chronic antigen-driven disease whereby food and/or aeroallergens induce a chronic inflammatory infiltrate in the esophagus leading to pathological hyperplasia of the epithelial and muscular layers, fibrosis of the lamina propria and symptoms of dysphagia and food impaction. Eosinophilic esophagitis is often associated with other allergic diseases such as asthma or atopic dermatitis. Current first line treatments of the disease include strict dietary modification and topical anti-inflammatory steroids. In this review the authors summarize currently available treatment strategies of eosinophilic esophagitis. Orv. Hetil, 2015, 156(23), 927-932.
    Full-text · Article · Jun 2015 · Orvosi Hetilap
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    • "Eosinophilic esophagitis (EoE) represents an emerging gastrointestinal disorder characterized by symptoms of esophageal dysfunction, including dysphagia and food impaction, along with marked esophageal eosinophilia in mucosal biopsies, both of which persist after treatment for acid gastroesophageal reflux [1] . First defined 20 years ago as a distinctive clinico-pathological syndrome [2], EoE currently represents an emerging chronic disease that usually persists from childhood into adulthood [3@BULLET, 4], with an estimated prevalence of 43–56 cases/100,000 inhabitants in both America and Europe, affecting both children and adults5678. EoE has been related to allergies since its first descriptions . "
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    ABSTRACT: Twenty years after it was first described, eosinophilic esophagitis (EoE) is now recognized as a prevalent disorder, representing the second most common cause of chronic esophagitis (after gastroesophageal reflux) and constituting the main cause of esophageal symptoms in young patients. In most cases the disease is triggered and maintained by exposure to food antigens, thus representing a novel form of food allergy. While topical steroids still constitute the prevailing therapeutic option, there is increased interest in dietary therapy as a treatment alternative capable of inducing and maintaining drug-free remission of the disease. First assessed in a pediatric series, more recent studies have demonstrated that dietary therapy is equally effective for adult sufferers of EoE. Indeed, various types of dietary interventions that either eliminate or reduce food antigens from the diet have been shown to induce remission of esophageal inflammation and its derived symptoms in a high proportion of patients. After remission has been achieved, food reintroduction is an essential part of the dietary management of EoE and should always be considered once esophageal biopsies are normal. Food reintroduction consists of a food allergy challenge that facilitates the identification of specific food triggers for the disease. This allows patients to follow as normal a diet as possible, thus improving the acceptance of and adherence to specific dietary restrictions.The dietary management of EoE is a challenging therapy that should be considered for every patient with the disease. Its major limitations arise from the necessity of repeated endoscopies with biopsies during the food reintroduction protocol, as well as from the absence of noninvasive subrogated markers of disease activity. For these reasons, the use of dietary therapy has been limited to highly motivated patients who are reluctant to utilize drug-based therapies on a chronic basis, as well as to highly motivated health-care providers.Ongoing research on less restrictive dietary options should facilitate the spread of dietary interventions, making this type of therapy more available for extended use.
    Full-text · Article · Jun 2014
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    • "Accumulating evidence has shown a strong familial association in EoE (15). Zink et al. (24) reported EoE to span over two generations in five out of seven families studied. "
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    ABSTRACT: Eosinophilic esophagitis (EoE) is an emerging disease characterized by esophageal eosinophilia (>15eos/hpf), lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast-cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with transforming growth factor-β to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE.
    Full-text · Article · May 2014 · Frontiers in Pediatrics
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