Eosinophilic Esophagitis: Prevalence, Diagnosis, and Treatment in Childhood and Adulthood.

Abstract

Background: Eosinophilic esophagitis is a chronic, Th2 immune-mediated disease of the esophagus characterized by eso - phageal dysfunction and predominant eosinophilic inflammation. Its prevalence and incidence have risen in recent years and now stand at 16.1 per 100 000 persons and 1.7 per 100 000 persons per year.

Methods: This review is based on selected publications retrieved by a search in PubMed, Medline, and Google Scholar for clinical trials, reviews, and guidelines that were published between 2011 and 2024 in either English or German (search term, "eosinophilic esophagitis").

Results: Eosinophilic esophagitis markedly impairs patients' quality of life; its diagnosis is often delayed. It can be treated with an appropriately altered diet, pharmacotherapy, and/or endoscopic intervention ("diet, drugs, dilatation"). Elimination diets with the omission of 2, 4, or 6 food groups lead to histological remission in 43%, 60%, and 79% of patients, respectively. An entirely amino acid-based diet leads to histological remission in over 90% of patients, but can only be performed for a limited time. Topical corticosteroids lead to histological remission in 60-87% of cases, proton-pump inhibitors in 30-50%, and dupilumab (anti-IL- 4Rα/IL-13Rα1) in 60-86%. These treatments differ widely in their side-effect profiles and in the restrictions they impose in everyday life, and their use must be considered individually for each patient. Because eosinophilic esophagitis is a chronic disease, remission maintenance therapy is needed over the long term.

Conclusion: Eosinophilic esophagitis was first described three decades ago. Effective treatments are available, but questions remain concerning the longterm course of the disease, remission maintenance therapy, and non-invasive markers of disease activity, among others. Delays in diagnosis should be avoided. The appropriate treatment and long-term care of the affected patients are needed to assure them an optimal quality of life.