Epidemiology and treatment of Eosinophilic Esophagitis: a narrative review

Abstract

Objective: Didactically review the general approach to Eosinophilic Esophagitis (EEo), discussing from epidemiology to treatment. Bibliographic review: The disease is characterized by the accumulation of eosinophils in the esophagus and has a higher incidence in adults. The pathophysiology of EEo is linked to genetic, environmental and allergenic factors, which attract eosinophils and T lymphocytes to the region. T helper 2 cells are stimulated to produce interleukins, which activate eosinophils and stimulate production of eotaxin-3 and reduced production of filaggrin and desmoglein 1, weakening the epithelial barrier and facilitating inflammation. Children have growth difficulties and weight gain, while adults have dysphagia, regurgitation and fullness. The diagnosis is made by the presence of 15 eosinophils in at least one of the six samples of esophageal biopsies performed endoscopically. The first line of treatment is used with Proton Pump Inhibitors and corticosteroids, along with diets. Mechanical dilation by endoscopy and the use of biologics are necessary when the patient does not respond to therapy. Final Considerations: EEo is a disease of difficult diagnosis with the presence of symptoms associated with Gastroesophageal Reflux Disease. When present, it must be quickly treated as a complication.