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Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring
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Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (18 February 2026) | Viewed by 10701

Special Issue Editors

Dr. Pierfrancesco Visaggi

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Guest Editor
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
Interests: eosinophilic esophagitis; eosinophilic gastrointestinal diseases; esophageal motility; esophageal physiology; gastroesophageal reflux disease (GERD); chronic esophageal diseases
Special Issues, Collections and Topics in MDPI journals
Prof. Edoardo Vincenzo Savarino

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Guest Editor
Division of Gastroenterology, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
Interests: eosinophilic esophagitis; gastroesophageal reflux disease (GERD); esophageal dysmotility; irritable bowel syndrome (IBS); inflammatory bowel disease (IBD)
Dr. Nicola De Bortoli

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Guest Editor
Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
Interests: eosinophilic esophagitis; gastroesophageal reflux disease (GERD); esophageal dysmotility; irritable bowel syndrome (IBS); inflammatory bowel disease (IBD)

Special Issue Information

Dear Colleagues,

We are delighted to announce a call for papers for a Special Issue of Journal of Clinical Medicine focused on the latest advances in the diagnosis, treatment, and monitoring of eosinophilic esophagitis (EoE). As a complex chronic, immune-mediated esophageal disease, EoE presents unique challenges in clinical practice and research, necessitating innovative approaches to improve patient outcomes.

This Special Issue seeks to gather insightful reviews that explore cutting-edge developments in the field of EoE. Topics of interest include, but are not limited to, novel diagnostic techniques, emerging therapeutic strategies, and advanced monitoring methods for EoE. We also welcome contributions addressing the underlying pathophysiology of the disease, patient-reported outcomes, and multidisciplinary management approaches.

By bringing together the latest findings from leading experts and researchers, this Special Issue aims to enhance our understanding of EoE and foster the development of more effective, personalized treatment plans. We encourage submissions that provide significant advancements and provoke thoughtful discussion within the medical and scientific communities.

Manuscripts should be submitted by February 2025 through the online submission system of JCM.

We look forward to receiving your submissions.

Dr. Pierfrancesco Visaggi
Prof. Edoardo Vincenzo Savarino
Dr. Nicola De Bortoli
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • eosinophilic esophagitis (EoE)
  • diagnosis 
  • treatment 
  • monitoring
  • disease assessment
  • precision medicine

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Published Papers (5 papers)

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Research

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13 pages, 757 KB  
Article
Prevalence of Sensitization to Panallergens and IgG4 Profiles Against Specific Foods in Patients with Allergic-Phenotype Eosinophilic Esophagitis
by Joan Domenech Witek, Rosario González Mendiola, Margarita Tomás Pérez, Ambrosia A. Vásquez Bautista, Vicente Jover Cerdá, Clara Carballas Vázquez, Miguel Ángel Echenagusia Abendibar, María de los Ángeles Gonzalez Labrado, Inmaculada Ibarra Calabui, Raquel de la Varga Martinez, Jorge Mannelli Rius and Diego Gutiérrez Fernández
J. Clin. Med. 2026, 15(5), 1728; https://doi.org/10.3390/jcm15051728 - 25 Feb 2026
Viewed by 438
Abstract
Background: The pathophysiological mechanism of eosinophilic esophagitis (EoE) is complex and is still being investigated. We believe that there is a group of patients with eosinophilic esophagitis which could be differentiated as having an allergic phenotype who exhibit a sensitization profile (aeroallergens, panallergens, [...] Read more.
Background: The pathophysiological mechanism of eosinophilic esophagitis (EoE) is complex and is still being investigated. We believe that there is a group of patients with eosinophilic esophagitis which could be differentiated as having an allergic phenotype who exhibit a sensitization profile (aeroallergens, panallergens, foods and specific IgG4 levels) with significant differences compared to patients with conventional allergic disease without associated eosinophilic esophagitis and healthy controls. Method: We measured the prevalence of sensitization to aeroallergens, foods and panallergens by means of molecular diagnostic techniques (ImmunoCAPTM ISAC) and determined the levels of specific IgG4 against foods and eosinophilic-derived neurotoxin (EDN) (ImmunoCAP technology) in patients with EoE of an allergic phenotype to study whether there are statistically significant differences with respect to the control groups (patients with different allergic pathologies without EoE and healthy patients without documented allergies). The total number of patients under study was 118, distributed among the different study groups. The case group (Allergic phenotype EoE patients) had 48 subjects. The food and respiratory allergy control groups had 30 subjects each. Finally, we included 10 in the healthy control group. Results: We were able to identify statistically significant differences when comparing levels of food-specific IgG4. Milk, egg, wheat, nuts, soy, cod, and Pru p3/LTP stood out. We did not observe significant differences in relation to sensitization to aeroallergens, foods, or panallergens. We also did not observe differences in EDN levels. Conclusions: We present a study in which statistically significant differences in IgG4 levels were observed in response to different types of food, comparing patients with eosinophilic esophagitis of allergic phenotype (case group) against subjects with allergic pathology without EoE and healthy subjects (control groups). Determining whether the detected foods are clinically relevant or not in these patients would be fundamental to establishing their usefulness as a treatment alternative in our patients. Full article
(This article belongs to the Special Issue Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring)
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12 pages, 691 KB  
Article
The Overlooked Burden of Atopic Comorbidities in Eosinophilic Esophagitis: Insights from a Real-Life Comprehensive Multidisciplinary Evaluation
by Marcella Pesce, Mario Ricchiuti, Elena Cantone, Maddalena Napolitano, Aikaterini Detoraki, Michele Falco, Pierpaolo De Giorgi, Roberto Berni Canani, Mauro Maniscalco and Giovanni Sarnelli
J. Clin. Med. 2025, 14(20), 7322; https://doi.org/10.3390/jcm14207322 - 16 Oct 2025
Viewed by 1478
Abstract
Background/Objectives: Eosinophilic esophagitis (EoE) is a T2-mediated disease characterized by dysphagia and food impaction. It is often associated with other atopic disorders and is considered a late manifestation of the “atopic march”. In clinical practice, allergic comorbidities are frequently underdiagnosed and primarily based [...] Read more.
Background/Objectives: Eosinophilic esophagitis (EoE) is a T2-mediated disease characterized by dysphagia and food impaction. It is often associated with other atopic disorders and is considered a late manifestation of the “atopic march”. In clinical practice, allergic comorbidities are frequently underdiagnosed and primarily based on self-reporting, potentially underestimating the true burden of T2-related pathology. To address this, a multidisciplinary task force was established at our tertiary center to systematically evaluate newly diagnosed patients with EoE. Methods: This cross-sectional observational study included patients referred for EoE evaluation from January 2022. Clinical history was collected prospectively, with systematic assessment for T2 comorbidities. All patients underwent an esophagogastroduodenoscopy with esophageal biopsies. Following EoE diagnosis, patients were referred to dermatology, ENT, immunology, and respiratory specialists. Results: A total of 43 patients were enrolled. Anamnestic T2 comorbidities were reported by 88% of patients. Rhinitis was the most common, while at baseline, no patients reported chronic rhinosinusitis with nasal polyps (CRSwNP). After specialist evaluation, diagnoses of asthma, food allergy, and atopic dermatitis remained stable, while eight patients previously reporting rhinitis were newly diagnosed with CRSwNP. Overall, 65% of patients had ≥2 T2 comorbidities in addition to EoE, and 25% had ≥3. Conclusions: Our findings support a multidisciplinary approach to assess T2 comorbidities in patients with EoE, with a high overall prevalence (95.3%) and frequent coexistence of multiple atopic conditions. CRSwNP was frequently underdiagnosed and only identified after rhinofibroscopy. Although our data needs to be confirmed in larger multicenter studies, our results suggest that relying solely on patient-reported history or single-specialty evaluation risks underestimating the systemic nature of the T2 inflammatory pathway in EoE. Full article
(This article belongs to the Special Issue Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring)
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10 pages, 216 KB  
Article
Navigating Care Amid Crisis: The Impact of the COVID-19 Pandemic on Eosinophilic Esophagitis Management in Canada
by Sunil Samnani, Muhammad Anas Fazal, Krystyna Pokraka, Joel David, Christopher N. Andrews, Michelle Buresi, Dorothy Y. Li, Matthew Woo, Christopher Ma and Milli Gupta
J. Clin. Med. 2025, 14(19), 6704; https://doi.org/10.3390/jcm14196704 - 23 Sep 2025
Viewed by 1044
Abstract
Background and Objectives: The COVID-19 pandemic caused significant disruptions in healthcare services. Foreign body impactions (FBIs), with Eosinophilic Esophagitis (EoE) being one of the leading underlying causes in adults, are some of the most common emergencies and often require endoscopy. The study [...] Read more.
Background and Objectives: The COVID-19 pandemic caused significant disruptions in healthcare services. Foreign body impactions (FBIs), with Eosinophilic Esophagitis (EoE) being one of the leading underlying causes in adults, are some of the most common emergencies and often require endoscopy. The study assesses the impact of COVID-19 on the incidence and outcomes of foreign body impactions (FBIs) requiring endoscopy at Canadian tertiary centres in a single city. Methods: Patients presenting to tertiary care hospital emergency departments in Calgary (March 2019–Feb 2022) for FBI were identified using the AACRS (Alberta Ambulatory Care Reporting System) database using International Classification of Disease (ICD-9 and ICD-10) codes (T178, T181) and provincial diagnostic codes (935.1, 530.4) for a foreign body in the esophagus (530.13 and K20.0). One-way ANOVA (SPSS® 27.0) analyzed incidence and disease progression across Pre-COVID-19 and COVID-19 years. Results: 759 patients were included in the analysis (274 Pre-COVID-19 (PC: March 2019–Feb 2020), 234 COVID-19 Year 1 (CY1: March 2020–Feb 2021), and 251 COVID-19 Year 2 (CY2: March 2021–Feb 2022)). The mean age remained consistent, with two-thirds being male. Food was the predominant type of FBI (>90%). The incidence of new EoE in EDs declined from PC (60.9%) to CY1 (47.4%) (p < 0.001), while endoscopic resolution remained >96%. Follow-up endoscopies in outpatient settings remained stable (~60%). Non-EoE causes of FBI, including esophagitis and cancer, increased in CY2. The mean ED length of stay rose in CY2, but this was not statistically significant (p = 0.06). Conclusions: This study highlights the resilience of emergent endoscopic care in Calgary during COVID, despite a decline in new EoE diagnoses, which might be due to access barriers. Full article
(This article belongs to the Special Issue Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring)

Review

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18 pages, 823 KB  
Review
Endoscopic Management of Eosinophilic Esophagitis: A Narrative Review on Diagnosis and Treatment
by Andrea Pasta, Francesco Calabrese, Manuele Furnari, Edoardo Vincenzo Savarino, Pierfrancesco Visaggi, Giorgia Bodini, Elena Formisano, Patrizia Zentilin, Edoardo Giovanni Giannini and Elisa Marabotto
J. Clin. Med. 2025, 14(11), 3756; https://doi.org/10.3390/jcm14113756 - 27 May 2025
Cited by 11 | Viewed by 4799
Abstract
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal eosinophilic infiltration, leading to symptoms such as dysphagia and food impaction. Endoscopy is central to both diagnosis and management, allowing for the direct visualization of characteristic features, biopsy collection, and therapeutic interventions. [...] Read more.
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease characterized by esophageal eosinophilic infiltration, leading to symptoms such as dysphagia and food impaction. Endoscopy is central to both diagnosis and management, allowing for the direct visualization of characteristic features, biopsy collection, and therapeutic interventions. Despite its diagnostic value, up to one-third of patients may present with a normal-appearing esophagus, highlighting the importance of standardized scoring systems and a systematic biopsy approach. This review explores the evolving role of endoscopy in EoE, from traditional diagnostic methods to emerging technologies such as EndoFlip™ for assessing esophageal distensibility, transnasal endoscopy for non-sedated monitoring, and novel dilation techniques for fibrostenotic disease. Additionally, non-invasive biomarkers and minimally invasive tools are reshaping disease monitoring. By integrating endoscopic, histologic, and molecular approaches, future advancements may enhance diagnostic accuracy and optimize personalized treatment strategies for EoE. Full article
(This article belongs to the Special Issue Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring)
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Other

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22 pages, 4573 KB  
Systematic Review
Comparative Efficacy and Safety of Swallowed Topical Corticosteroids in Eosinophilic Esophagitis: A Network Meta-Analysis
by Alfredo J. Lucendo, Ángel Arias, Celia Álvarez-Bueno, Vicente Martínez-Vizcaino and Iván Redondo-Cavero
J. Clin. Med. 2025, 14(21), 7823; https://doi.org/10.3390/jcm14217823 - 4 Nov 2025
Cited by 1 | Viewed by 2151
Abstract
Background: Swallowed topical corticosteroids (STCs) are used as the first-line therapy for eosinophilic esophagitis (EoE) and have been extensively studied in randomized controlled trials (RCTs); however, the presentation and doses varied widely among the studies. Aim: The goal of this study [...] Read more.
Background: Swallowed topical corticosteroids (STCs) are used as the first-line therapy for eosinophilic esophagitis (EoE) and have been extensively studied in randomized controlled trials (RCTs); however, the presentation and doses varied widely among the studies. Aim: The goal of this study was to compare the safety and effectiveness of the different STC-based options in EoE patients. Methods: We performed a literature search for RCTs, spanning a time period from database inception to July 2024, in order to compare the efficacy and safety of all STCs used to induce or maintain EoE remission each other and also with placebo or proton pump inhibitors (PPIs) in a network meta-analysis. Outcomes are expressed as pooled risk ratios (RRs) of failure and 95% confidence intervals (CIs), and we aimed to evaluate histological remission at <15–20 eosinophils per high-power field (eos/hpf), <5–6 eos/hpf, and <1 eos/hpf. The effect sizes for symptomatic improvement and the mean differences for endoscopic EREFS improvement with 95% CIs were also measured. Adverse events were evaluated using RRs, and these included oropharyngeal and esophageal candidiasis and adrenal suppression. Results: Twenty studies involving 1455 patients with active EoE reported on STC effectiveness to induce remission; three additional studies on 232 patients assessed the maintenance of remission. Budesonide 1 mg orodispersible tablets ranked highest in SUCRA in terms of all histological remission endpoints. Budesonide from inhalation devices was the only option superior to placebo in improving symptoms. Budesonide viscous suspension was the only option superior to placebo in improving endoscopy. No therapy was significantly associated with the risk of any adverse event. Significant inconsistencies and small study effects were detected in multiple comparisons. Conclusions: Budesonide orodispersible tablets were the best option for achieving EoE histological remission, but not symptomatic or endoscopic improvement. STC formulations were as safe as placebo or PPI. Full article
(This article belongs to the Special Issue Eosinophilic Esophagitis: Clinical Advances in Diagnosis, Treatment, and Monitoring)
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