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Minerva Gastroenterologica e Dietologica 2021 Jan 13

DOI: 10.23736/S1121-421X.20.02807-X


language: English

Eosinophilic esophagitis: novel concepts regarding pathogenesis and clinical manifestations

Giusi D. SCIUMÉ 1, Pierfrancesco VISAGGI 1, Andrea SOSTILIO 1, Luca TARDUCCI 1, Camilla PUGNO 1, Marzio FRAZZONI 2, Angelo RICCHIUTI 1, Massimo BELLINI 1, Edoardo G. GIANNINI 3, Santino MARCHI 1, Vincenzo SAVARINO 3, Nicola DE BORTOLI 1

1 Division of Gastroenterology, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy; 2 Digestive Pathophysiology Unit, Baggiovara Hospital, Modena, Italy; 3 Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy


Eosinophilic esophagitis is a chronic disease whose incidence and prevalence are increasing, based on a genetic-driven interaction between environment and immune system. Several gene loci involved in the development of the disease have been identified. A two-step mechanism has been hypothesized: a TSLP-induced allergic sensitization followed by upregulation of CAPNA14-related esophageal-specific pathways. Environment seems to have a larger effect than genetic variants. Factors that could play a role are allergens, drugs, colonizing bacteria and possibly Helicobacter Pylori infection. Acting on these modifiable risk factors may be a tool to prevent the disease. EoE is characterized by a typical eosinophilic infiltrate limited to the esophageal epithelium, supported by a Th2-mediated immune response, found in other atopic conditions. The key of the pathogenesis is the disfunction of the epithelial barrier which allow the interaction between allergens and inflammatory cells. Eosinophilic-predominant inflammation leads to the typical wall remodeling, histologically characterized by epithelial and smooth muscle hyperplasia, lamina propria fibrosis and neo-angiogenesis. These alterations find their clinical expression in the pattern of symptoms: dysphagia, food impaction, chest pain, heartburn.

KEY WORDS: Eosinophilic esophagitis; Pathophysiology; Dysphagia; Bolus impaction

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