Eosinophilic Esophagitis Diagnosis and Management

Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated disorder of the oesophagus characterised by marked infiltration of eosinophils in the mucosa and submucosa. Clinically, adults present predominantly with dysphagia and food impaction, whereas children more often exhibit vomiting, abdominal pain or feeding aversion. Diagnosis relies on upper endoscopy with targeted biopsies demonstrating at least 15 eosinophils per high-power field and exclusion of gastro-oesophageal reflux disease through a trial of proton pump inhibitor therapy or pH monitoring. Endoscopic features range from concentric rings and longitudinal furrows to white exudates and fibrostenotic strictures. Management involves a personalised strategy combining dietary elimination—such as empirical six-food exclusion or elemental diets—with pharmacotherapy. Swallowed topical corticosteroids and proton pump inhibitors form first-line agents, and endoscopic dilation is reserved for established fibrostenosis. Emerging biologics targeting interleukin-5 and interleukin-13 pathways show promise in refractory cases. Long-term monitoring of histological remission, oesophageal remodelling and quality of life is essential to prevent progression to stricturing disease and to tailor maintenance therapy.

Research from Nature Portfolio

A comprehensive single-cell atlas of the human oesophageal mucosa during active EoE and remission has delineated 60 discrete cell subsets, revealing profound alterations in epithelial, immune and stromal compartments. Active disease is marked by enrichment of ALOX15-positive macrophages, PRDM16-expressing dendritic cells bearing EoE risk alleles and proliferating mast cells, alongside a relative paucity of TH17 lymphocytes. Ligand–receptor analyses uncover programmes of eosinophil recruitment, enhanced fibroblast–immune crosstalk and putative interactions between IL-9+IL-4+IL-13+ TH2 cells and endothelial or mast cell populations. Resolution of inflammation correlates with contraction of tissue-resident mast and TRM cells and downregulation of eosinophil chemoattractants, offering cell type–specific targets for the restoration of oesophageal homeostasis.

Eosinophilic Esophagitis Diagnosis and Management publication trend

The graph below shows the total number of articles in eosinophilic esophagitis diagnosis and management across all publications each year (not limited to Nature Index journals).

Technical terms

Eosinophilic oesophagitis (EoE): A chronic allergic inflammation of the oesophagus marked by ≥15 eosinophils per high-power field on biopsy.

Eosinophil: A granulocytic white blood cell involved in type 2 immune responses and tissue remodelling in allergic disorders.

Group 2 innate lymphoid cells (ILC2s): Innate immune cells that produce type 2 cytokines and growth factors such as amphiregulin, contributing to epithelial remodelling.

Amphiregulin: A member of the epidermal growth factor family secreted by ILC2s that binds EGFR and promotes epithelial proliferation.

Peak eosinophil count: The highest number of eosinophils observed per high-power microscopic field in oesophageal biopsy specimens.

Proton pump inhibitors (PPIs): Acid-suppressing medications that also exhibit anti-inflammatory effects in the oesophagus, used diagnostically and therapeutically in EoE.

References

1. Esophageal ILC2s mediate abnormal epithelial remodeling in eosinophilic esophagitis via Areg-EGFR signaling. Cellular & Molecular Immunology (2024).
2. An esophagus cell atlas reveals dynamic rewiring during active eosinophilic esophagitis and remission. Nature Communications (2024).
3. Development of a core outcome set for therapeutic studies in eosinophilic esophagitis (COREOS). Journal of Allergy and Clinical Immunology (2021).