Good review:  Glenn T. Furuta, M.D., and David A. Katzka, M.D. N Engl J Med 2015; 373:1640-1648

A couple pointers from this review:

• Estimated prevalence of eosinophilic esophagitis (EoE) 0.4% in Western countries.  Symptoms are often underestimated due to patient ‘accommodation’ which includes eating slowly/carefully, drinking a lot of liquids and avoiding items more prone to become lodged (meats, pills, breads)
• Pathogenesis: “Birth by cesarean section, premature delivery, antibiotic exposure during infancy, food allergy, lack of breast-feeding, and living in an area of lower population density have all been associated with eosinophilic esophagitis.”
• Impaired barrier function and enhanced the activity play a role in pathogenesis
• Food allergy is a non-IgE-mediated process.  Omalizumab, an anti-IgE biologic, is ineffective in EoE and EoE can develop in IgE-null mice
• Male predominance (3:1) suggests that there is a genetic component.

Esophagus with ringed appearance, furrowing, and loss of vascular markings

Another useful reference on Eosinophilic Gastritis in Children: Am J Gastroenterol 2014; 109; 1277-85.  This article provides data on clinical and histologic remission with eosinophilic gastritis (>70 eos/hpf), n=30 children.  “Response to dietary restriction was high” (82% clinical, 78% histologic response) Thanks to Seth Marcus for this reference.

Related blog posts:

• Looking Twice for Eosinophilic Esophagitis | gutsandgrowth
• Higher Doses of Topical Steroids for Eosinophilic Esophagitis
• Eosinophilic Esophagitis Slide Set | gutsandgrowth
• How Common is Eosinophilic Esophagitis? | gutsandgrowth
• Systemic Review of Dietary Treatments… | gutsandgrowth
• Do We Still Need PPI-REE? | gutsandgrowth
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