What is the difference between Metabolic Dysfunction-Associated Steatotic Liver Disease, Eosinophilic Esophagitis and Gastroesophageal Reflux Disease?

Abstract

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is emerging as a key hepatic manifestation of metabolic syndrome that affects nearly 40% of the global population. While links between MASLD and conditions such as type 2 diabetes and cardiovascular disease are well recognized, recent evidence suggests a potential connection with eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD). This editorial explores overlapping pathophysiology and inflammatory mechanisms shared by MASLD, EoE, and GERD, drawing from the current global literature and a multicenter U.S. cohort study. This editorial highlights how systemic inflammation, oxidative stress, and gut microbiota imbalance may drive these associations. Notably, MASLD was associated with a 2.38-fold increased risk of EoE and a modest but significant association with GERD independent of obesity. These findings underscore the importance of considering MASLD beyond liver-specific pathology and call for further research on shared immunometabolic pathways. An improved awareness of these relationships may guide diagnostic and therapeutic strategies in clinical practice.