Eosinophilic esophagitis – discussion of the current state of knowledge and new possibilities for biological treatment
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University Clinical Hospital of the Military Academy of Medicine – Central Veterans Hospital, Polska
Uniwersytet Medyczny w Łodzi, Polska
Szpital Zakonu Bonifratrów św. Jana Grandego, Polska
Corresponding author
Aleksander Gras-Ozimek   

University Clinical Hospital of the Military Academy of Medicine – Central Veterans Hospital, ul. Żeromskiego
Med Og Nauk Zdr. 2024;30(1):1-6
Introduction and objective:
Eosinophilic esophagitis is an immune-mediated disease. Clinically, it is characterized by esophageal dysfunction, and histologically – by inflammatory infiltration of eosinophils in the wall of this organ. Chronic inflammation in the esophageal wall leads to structural changes and, secondarily, to increasing symptoms of dysphagia. The aim of this study is to discuss current knowledge about eosinophilic esophagitis and new treatment options for this disease.

Review methods:
The PubMed database was used to review the literature. An electronic literature search was conducted, limited to specific years of publication (2007–2023), using search terms in the form of the following phrases in English: „Eosinophilic esophagitis“, „Eosinophilic esophagitis treatment“, „Eosinophilic esophagitis biological treatment“, „Eosinophilic esophagitis epidemiology“. All retrieved articles were analyzed. The review included original studies, as well as randomized, double-blind, placebo-controlled studies.

Brief description of the state of knowledge:
The etiology of eosinophilic esophagitis has still not been precisely defined. It is believed that the direct cause of eosinophilic esophagitis is impaired function of the esophageal epithelium and eosinophils. Drugs used so far, such as PPIs and GCs, do not provide fully satisfactory results for patients, hence the search for a more optimal therapy is ongoing.

Eosinophilic esophagitis is a disease that significantly reduces the quality of life of patients – current therapeutic options do not always permit long-term remission of symptoms. An increasingly better understanding of the pathomechanism of the disease allows for the introduction of precisely targeted treatment. Great hopes are placed on biological therapy.

Dhar A, Haboubi HN, Attwood SE, et al. British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022 Aug;71(8):1459–1487. doi:10.1136/gutjnl-2022-327326. Epub 2022 May 23. PMID: 35606089; PMCID: PMC9279848.
Jarocka-Cyrta E. Eozynofilowe zapalenie przełyku. In: Dąbrowski A. Wielka Interna Gastroenterologia. 2nd ed. Warszawa: Medical Tribune Polska; 2019. vol. 2. p. 517–521.
Clayton F, Fang JC, Gleich GJ, et al. Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE. Gastroenterology. 2014 Sep;147(3):602–9. doi:10.1053/j.gastro.2014.05.036. Epub 2014 Jun 4. PMID: 24907494.
Navarro P, Arias Á, Arias-González L, et al. Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther. 2019 May;49(9):1116–1125. doi:10.1111/apt.15231. Epub 2019 Mar 18. PMID: 30887555.
Arias Á, Lucendo AJ. Epidemiology and risk factors for eosinophilic esophagitis: lessons for clinicians. Expert Rev Gastroenterol Hepatol. 2020 Nov;14(11):1069–1082. doi:10.1080/17474124.2020.1806054. Epub 2020 Aug 24. PMID: 32749898.
O'Shea KM, Aceves SS, Dellon ES, et al. Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2018 Jan;154(2):333–345. doi:10.1053/j.gastro.2017.06.065. Epub 2017 Jul 27. PMID: 28757265; PMCID: PMC5787048.
Abonia JP, Wen T, Stucke EM, et al. High prevalence of eosinophilic esophagitis in patients with inherited connective tissue disorders. J Allergy Clin Immunol. 2013 Aug;132(2):378–86. doi:10.1016/j.jaci.2013.02.030. Epub 2013 Apr 19. PMID: 23608731; PMCID: PMC3807809.
Gratacós Gómez AR, Gómez Torrijos E. Eosinophilic Esophagitis due to Aeroallergens: A Systematic Review and Update. J Investig Allergol Clin Immunol. 2022 Dec 15;32(6):438–450. doi:10.18176/jiaci.0853. Epub 2022 Aug 24. PMID: 36000828.
Fahey L, Robinson G, Weinberger K, et al. Correlation Between Aeroallergen Levels and New Diagnosis of Eosinophilic Esophagitis in New York City. J Pediatr Gastroenterol Nutr. 2017;64(1):22–5.
Wang FY, Gupta SK, Fitzgerald JF. Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children? J Clin Gastroenterol. 2007;41(5):451–3.
Larsson H, Bergquist H, Bove M. The incidence of esophageal bolus impaction: is there a seasonal variation? Otolaryngol Heal Neck Surg. 2011;144:186–90.
Patel RV, Hirano I, Gonsalves N. Eosinophilic Esophagitis: Etiology and Therapy. Annu Rev Med. 2021 Jan 27;72:183–197. doi:10.1146/annurev-med-052819-023848. Epub 2020 Nov 23. PMID: 33228437.
Molina-Infante J, Lucendo AJ. Proton Pump Inhibitor Therapy for Eosinophilic Esophagitis: A Paradigm Shift. Am J Gastroenterol. 2017 Dec;112(12):1770–1773. doi:10.1038/ajg.2017.404. Epub 2017 Oct 31. PMID: 29087399.
Lucendo AJ, Arias Á, Molina-Infante J. Efficacy of Proton Pump Inhibitor Drugs for Inducing Clinical and Histologic Remission in Patients With Symptomatic Esophageal Eosinophilia: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol. 2016 Jan;14(1):13–22.e1. doi:10.1016/j.cgh.2015.07.041. Epub 2015 Aug 3. PMID: 26247167.
Lucendo AJ. Pharmacological treatments for eosinophilic esophagitis: current options and emerging therapies. Expert Rev Clin Immunol. 2020 Jan;16(1):63–77. doi:10.1080/1744666X.2019.1705784. Epub 2020 Jan 6. PMID: 31842634.
Gutiérrez-Junquera C, Fernández-Fernández S, Cilleruelo ML, et al. High Prevalence of Response to Proton-pump Inhibitor Treatment in Children With Esophageal Eosinophilia. J Pediatr Gastroenterol Nutr 2016;62(5):704–710.
Molina-Infante J, Rodriguez-Sanchez J, Martinek J, et al. Long-Term Loss of Response in Proton Pump Inhibitor-Responsive Esophageal Eosinophilia Is Uncommon and Influenced by CYP2C19 Genotype and Rhinoconjunctivitis. Am J Gastroenterol 2015;110(11):1567–1575.
Gómez-Torrijos E, García-Rodríguez R, Castro-Jiménez A, et al. The efficacy of step-down therapy in adult patients with proton pump inhibitor-responsive oesophageal eosinophilia. Aliment Pharmacol Ther. 2016;43(4):534–540.
Rank MA, Sharaf RN, Furuta GT, et al. AGA Institute. Electronic address:; Joint Task Force on Allergy-Immunology Practice Parameters collaborators. Electronic address:; AGA Institute; Joint Task Force on Allergy-Immunology Practice Parameters collaborators. Technical review on the management of eosinophilic esophagitis: a report from the AGA institute and the joint task force on allergy-immunology practice parameters. Ann Allergy Asthma Immunol. 2020 May;124(5):424–440.e17. doi:10.1016/j.anai.2020.03.021. PMID: 32336463; PMCID: PMC8171057.
Muir A, Falk GW. Eosinophilic Esophagitis: A Review. JAMA. 2021 Oct 5;326(13):1310–1318. doi:10.1001/jama.2021.14920. PMID: 34609446; PMCID: PMC9045493.
Lucendo AJ, Miehlke S, Schlag C, et al. International EOS-1 Study Group. Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology. 2019 Jul;157(1):74–86.e15. doi:10.1053/j.gastro.2019.03.025. Epub 2019 Mar 26. PMID: 30922997.
Dellon ES, Woosley JT, Arrington A, et al. Efficacy of Budesonide vs Fluticasone for Initial Treatment of Eosinophilic Esophagitis in a Randomized Controlled Trial. Gastroenterology. 2019 Jul;157(1):65–73.e5. doi:10.1053/j.gastro.2019.03.014. Epub 2019 Mar 11. PMID: 30872104; PMCID: PMC6581596.
Hirano I, Collins MH, Katzka DA, et al. ORBIT1/SHP621-301 Investigators. Budesonide Oral Suspension Improves Outcomes in Patients With Eosinophilic Esophagitis: Results from a Phase 3 Trial. Clin Gastroenterol Hepatol. 2022 Mar;20(3):525–534.e10. doi:10.1016/j.cgh.2021.04.022. Epub 2021 Apr 19. Erratum in: Clin Gastroenterol Hepatol. 2022 Oct;20(10):2418. PMID: 33887475.
Hirano I, Chan ES, Rank MA, et al. AGA Institute Clinical Guidelines Committee; Joint Task Force on Allergy-Immunology Practice Parameters. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Gastroenterology. 2020 May;158(6):1776–1786. doi:10.1053/j.gastro.2020.02.038. PMID: 32359562; PMCID: PMC9473154.
Kucharczyk A. Leczenie biologiczne w eozynofilowym zapaleniu przełyku. In: Kucharczyk A. Leczenie biologiczne w alergologii. Warszawa: PZWL Wydawnictwo Lekarskie; 2022. p. 225–239.
Hirano I, Dellon ES, Hamilton JD, et al. Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis. Gastroenterology. 2020 Jan;158(1):111–122.e10. doi:10.1053/j.gastro.2019.09.042. Epub 2019 Oct 5. PMID: 31593702.
Dellon ES, Spergel JM. Biologics in eosinophilic gastrointestinal diseases. Ann Allergy Asthma Immunol. 2023 Jan;130(1):21–27. doi:10.1016/j.anai.2022.06.015. Epub 2022 Jun 20. PMID: 35738437; PMCID: PMC10191215.
Loizou D, Enav B, Komlodi-Pasztor E, et al. A pilot study of omalizumab in eosinophilic esophagitis. PLoS One. 2015 Mar 19;10(3):e0113483. doi:10.1371/journal.pone.0113483. PMID: 25789989; PMCID: PMC4366078.
Straumann A, Conus S, Grzonka P, et al. Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomised, placebo-controlled, double-blind trial. Gut. 2010;59:21–30.
Assa›ad AH, Gupta SK, Collins MH, et al. An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis. Gastroenterology. 2011 Nov;141(5):1593–604. doi:10.1053/j.gastro.2011.07.044. Epub 2011 Aug 9. PMID: 21835135.
Arias A, González-Cervera J, Tenias JM, et al. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014 Jun;146(7):1639–48. doi:10.1053/j.gastro.2014.02.006. Epub 2014 Feb 15. PMID: 24534634.
Chawla K, Alabbas B, Sheth D, et al. As Easy as EoE: A Novel and Effective Multidisciplinary Approach to Care of Patients with Eosinophilic Esophagitis in the Age of Biologics. Dig Dis Sci. 2020 Aug;65(8):2196–2202. doi:10.1007/s10620-020-06366-4. PMID: 32519139.
Moawad FJ, Molina-Infante J, Lucendo AJ, et al. Systematic review with meta-analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis. Aliment Pharmacol Ther. 2017;46:96–105.
Lucendo AJ, Molina-Infante J. Esophageal dilation in eosinophilic esophagitis: risks, benefts, and when to do it. Curr Opin Gastroenterol. 2018;1:226–232.
Lim AH, Wong S, Nguyen NQ. Eosinophilic Esophagitis and IgG4: Is There a Relationship? Dig Dis Sci. 2021 Dec;66(12):4099–4108. doi:10.1007/s10620-020-06788-0. Epub 2021 Feb 3. PMID: 33534011.
Dellon ES, Gonsalves N, Hirano I, et al. American College of Gastroenterology. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013 May;108(5):679–92; quiz 693. doi:10.1038/ajg.2013.71. Epub 2013 Apr 9. PMID: 23567357.
Horvath A. Eozynofilowe zapalenie przełyku. In: Jahnz-Różyk K, Kupczyk M, Gawlik R. Alergologia w praktyce klinicznej. Warszawa: PZWL Wydawnictwo Lekarskie; 2023. vol. 2. p. 193–206.
Anyane-Yeboa A, Wang W, Kavitt RT. The Role of Allergy Testing in Eosinophilic Esophagitis. Gastroenterol Hepatol (N Y). 2018;14(8):463–469.
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