Diagnostics and treatment of eosinophilic esophagitis Diagnostik und Therapie der eosinophilen Ösophagitis
Hölz H, Hörning A (2025)
Publication Type: Journal article
Publication year: 2025
Journal
DOI: 10.1007/s00112-025-02235-4
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammation of the esophagus immune-mediated by type 2 helper cells (TH2) characterized by esophageal dysfunction and predominantly eosinophilic inflammation. The estimated prevalence is 1 in 2000. It is caused by a disturbed gene-environment interaction with risk factors in genes related to the epithelial barrier and mediators of allergic inflammation. Triggers of the inflammation are allergens in food (especially cow’s milk, wheat, eggs) or airborne allergens. Other TH2‑mediated diseases, such as allergic rhinitis, asthma, or atopic dermatitis, are often present. In toddlers and early infancy, symptoms are often nonspecific, while older children, adolescents and adults have dysphagia, regurgitation, heartburn or bolus obstruction. The disease is diagnosed when there are symptoms of esophageal dysfunction along with tissue eosinophilia of ≥ 15 eosinophilic granulocytes per high power field (hpf) in one of at least 6 biopsies from at least 2 sections of the esophagus. If there is a strong clinical suspicion of EoE but few or no eosinophils are detectable in the esophageal biopsies, the possibility of other causes should be considered. Treatment consists of the three D’s: diet, drugs and dilatation. A step-up dietary approach prioritizing a milk elimination diet is recommended. The pharmacotherapy includes proton pump inhibitors (PPIs), topical corticosteroids (TCS) and the biologic dupilumab (for children aged ≥ 1 year and weighing ≥ 15 kg). In the case of treatment-refractory symptomatic esophageal strictures, endoscopic dilation followed by TCS treatment is recommended. Treatment monitoring should take the symptoms, quality of life and endoscopy with histological findings into account.
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APA:
Hölz, H., & Hörning, A. (2025). Diagnostics and treatment of eosinophilic esophagitis Diagnostik und Therapie der eosinophilen Ösophagitis. Monatsschrift Kinderheilkunde. https://doi.org/10.1007/s00112-025-02235-4
MLA:
Hölz, Hannes, and André Hörning. "Diagnostics and treatment of eosinophilic esophagitis Diagnostik und Therapie der eosinophilen Ösophagitis." Monatsschrift Kinderheilkunde (2025).
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Germany (DE)