Eosinophilic Esophagitis









Ikuo Hirano, MD, Editor
Eosinophilic esophagitis (EoE) has emerged over the past two decades as an important cause of upper gastrointestinal symptoms in both adults and children. Defined as a chronic, immune/antigen-mediated esophageal disease, EoE presents in children with manifestations of nausea, vomiting, abdominal pain, and feeding difficulty; in adults, it presents as a leading cause of dysphagia. Food impaction requiring emergent endoscopic extraction is a common, untoward consequence of unrecognized and untreated EoE. Once considered rare, the prevalence of EoE is currently estimated at 0.5 to 1 case per 1000, approaching the prevalence of inflammatory bowel disease. Furthermore, the prevalence continues to steadily rise, paralleling the rise of atopic diseases.


This issue of Gastroenterology Clinics of North America includes perspectives and reviews by clinicians and investigators dedicated to the advancement of our knowledge of EoE. Although eosinophilic gastrointestinal disorders are now recognized worldwide, there are many areas of controversy and uncertainty. Insights into the rising prevalence, diagnostic criteria, genetic predisposition, allergic mechanisms, interactions with gastroesophageal reflux disease, and measurement of disease activity have generated as many questions as answers. Therapeutic options of medications, endoscopically directed esophageal dilation, and diet therapy by eliminating food triggers are utilized in practice but no pharmaceutical treatments are currently approved by the US Food and Drug Administration. Indeed, the definition, appropriate assessment, and optimal management of EoE continue to evolve.


This issue begins and ends with unique perspectives from three of the individuals credited with the initial recognition and advancement of EoE. The intervening articles are authored by international experts from pediatric and adult gastroenterology, immunology, allergy, pathology, and basic science research, emphasizing the important and fundamental collaborative efforts inspired by this new and interdisciplinary entity. Central contributions from dieticians and health care psychologists are evident in the discussions on the primary role of diet therapy and disease impact on quality of life, respectively. The topic of “extraesophageal” eosinophilic gastrointestinal disorders is addressed in a specific article as well as in the review on histopathology. Finally, I would like to acknowledge that many of the articles in this issue were authored by members of The International Gastrointestinal Eosinophil Researchers (TIGERS). Over the past decade, TIGERS has led educational and research efforts to define eosinophilic gastrointestinal disorders. The consensus recommendations authored by the TIGERS group in 2007 and 2011 have fundamentally shaped the current concepts and identification of unmet needs in eosinophilic gastrointestinal disorders.


I thank my distinguished colleagues for contributing to this issue of Gastroenterology Clinics of North America . I hope you will find the information useful for current clinical practice and future investigations into this important disease.


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Sep 6, 2017 | Posted by in GASTROENTEROLOGY | Comments Off on Eosinophilic Esophagitis

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