Search Results (167)

Eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD) are immune-mediated disorders of the gastrointestinal (GI) tract that, despite involving different tissues, are increasingly recognized to coexist. Epidemiologic studies demonstrate a bidirectional association, with patients affected by one condition showing a higher-than-expected prevalence of the other, suggesting shared susceptibility rather than incidental overlap. Genetic and epigenetic data support partial convergence in immune regulatory pathways, while epithelial barrier dysfunction and antigen-driven immune activation emerge as common upstream features. Overlapping cytokine networks, including IL-4, IL-13, and IL-23 signaling, contribute to chronic inflammation in both diseases, although differences in tissue environment and immune dominance give rise to distinct inflammatory phenotypes and clinical behavior. Clinical outcomes in patients with dual diagnoses appear heterogeneous, with available data suggesting neither uniformly worsened nor clearly protective disease courses, underscoring the complexity of shared immune mechanisms operating within different anatomic contexts. Beyond inflammatory activity, coexistence of EoE and IBD poses important nutritional and quality-of-life challenges, as overlapping dietary restrictions and chronic symptoms increase the risk of malnutrition, micronutrient deficiencies, and psychosocial burden. Current therapies remain disease-specific, with strong evidence supporting proton pump inhibitors, swallowed topical steroids, dietary therapy, and dupilumab in EoE, and biologics and small molecules targeting TNF-α, IL-12/23, IL-23, integrins, and JAK–STAT signaling in IBD, while evidence guiding treatment in patients with dual diagnosis remains limited. Together, current evidence supports a framework of shared immune machinery with tissue-specific expression that explains coexistence while preserving the distinct identities of EoE and IBD. By integrating emerging genetic, immunologic, and clinical evidence, this review aims to provide a framework for understanding and managing patients with coexisting EoE and IBD. Full article

Food allergy (FA) and eosinophilic esophagitis (EoE) represent two of the most rapidly increasing allergen-driven conditions in pediatric medicine. Both diseases share key immunological features, including Th2 polarization and epithelial barrier dysfunction. Over the past two decades, compelling epidemiological and mechanistic evidence has established EoE as a late-manifesting component of the allergic march—the well-recognized sequential progression of atopic disease in childhood, which typically begins with atopic dermatitis, followed by IgE-mediated food allergy, allergic rhinitis, and asthma. Children with IgE-mediated food allergy carry a substantially elevated risk of developing EoE, and shared genetic susceptibility loci—including CAPN14, TSLP, and filaggrin (FLG)—underscore common pathogenic pathways. We conducted a narrative review of the literature by systematically searching PubMed/MEDLINE, EMBASE, and the Cochrane Library using the terms “eosinophilic esophagitis,” “food allergy,” “atopic march,” “IgE-mediated allergy,” and “pediatric” in combination; articles published from 2000 to March 2026 were considered, with priority given to systematic reviews, meta-analyses, randomized controlled trials, and guideline documents. This narrative review comprehensively examines the epidemiology, pathomechanisms, clinical presentation, diagnostic approach, and therapeutic landscape for pediatric FA and EoE, with particular emphasis on their immunological intersections and the evolving evidence positioning EoE within atopic disease trajectories. We highlight approval of dupilumab for children as young as 1 year with EoE—representing a paradigm shift toward biologic therapy for atopic multimorbidity—and discuss the pipeline of emerging agents including cendakimab, lirentelimab, and anti-IL-5 strategies. Identification of shared pathogenic mechanisms offers promising avenues for unified prevention, early diagnosis, and precision therapeutic approaches for children with multiple atopic diseases. Full article

Alterations in gastrointestinal function (digestion, absorption, motility, secretion, and elimination) play important roles in the pathophysiology of many gastrointestinal disorders. Food also strongly influences gastrointestinal health and disease. Some foods act as antigens that trigger an enteric immune response, while others can serve as substrates with direct or indirect biological effects. Food can also be metabolized by gut microbes into bioactive molecules that alter physiology. This review discusses the current research evidence and the clinical use of “food as medicine” through dietary therapies for the management of various gastrointestinal conditions, including disorders of gut–brain interaction, eosinophilic esophagitis, celiac disease, inflammatory bowel disease, gastroparesis, and short bowel syndrome with intestinal failure. Full article

Background/Objectives: To evaluate the long-term effects of eosinophilic esophagitis (EoE) on the nutritional status and growth of children. Methods: We performed a retrospective cohort study to assess longitudinal growth patterns (height and BMI z-scores) in pediatric patients (<18 years) newly diagnosed with EoE and followed for at least one year. Nutritional status was classified using BMI-based criteria from the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition and the World Health Organization. Results: Among 50 patients, 20% presented with impaired nutritional status at diagnosis, including 12% with moderate malnutrition (BMI z-score < −2) and 8% with obesity (BMI z-score > +2). After a mean follow-up of 24.5 months, the prevalence of moderate malnutrition decreased to 6%, whereas obesity increased to 12%. Height z-scores remained largely stable over the follow-up period. Conclusions: EoE affects children across the full BMI spectrum. Long-term follow-up highlights the importance of monitoring nutritional status in all pediatric patients with EoE, given the risks of both malnutrition and obesity during disease management. Full article

Background/Objectives: The recommendation of routine gastric and duodenal biopsies at index endoscopy on suspicion of eosinophilic esophagitis (EoE) remains controversial because of the limited supporting evidence. We aimed to evaluate the prevalence, clinical relevance, and predictors of gastric and duodenal histopathology in a large real-world EoE cohort. Methods: This retrospective single-center study included adult and pediatric patients with EoE diagnosed between 2001 and 2024 and enrolled in the EoE CONNECT registry. Gastric and/or duodenal biopsies obtained at diagnosis or follow-up were reviewed. Histologic findings were classified into specific diagnostic categories and analyzed according to clinical presentation, endoscopic features, and age group. Results: We evaluated 340 patients (35.7% children), of whom 88.5% underwent both gastric and duodenal biopsies. The overall diagnostic yield for extra-esophageal findings was 20.9%, predominantly Helicobacter pylori-associated gastritis (18.8%), but with a very low yield of clinically meaningful diagnoses such as celiac disease (0.6%) and eosinophilic gastritis (0.3%). Symptoms and endoscopic abnormalities were not significantly associated with pathological findings ($p=0.11$). Moreover, age-stratified analysis revealed no significant differences in specific diagnoses, although patients with pathological extra-esophageal biopsies were significantly older ($p<0.001$). Follow-up biopsies demonstrated resolution of most pathological findings after the initial diagnosis, with Helicobacter pylori-associated gastritis accounting for the majority of cases that resolved. Conclusions: Routine extra-esophageal biopsies in the context of patients with EoE have a low diagnostic yield and rarely alter clinical management, regardless of age. Therefore, our findings advocate for a selective rather than universal approach to extra-esophageal sampling in patients with EoE. Full article

Eosinophils are multifunctional granulocytes that reside constitutively within mucosal tissues, where they engage in bidirectional communication with the epithelial cells lining the respiratory and gastrointestinal (GI) tracts. Once regarded solely as terminal effectors of the type 2 immunity, eosinophils are now recognized as key regulators of epithelial homeostasis and barrier integrity. Epithelial cells initiate crosstalk by releasing the alarm cytokines such as interleukin (IL)-33, thymic stromal lymphopoietin (TSLP), and IL-25, which drive eosinophil recruitment, activation, and tissue retention. Conversely, eosinophils modulate epithelial function through the release of granule proteins, cytokines, and growth factors with both damaging and reparative consequences. In the airway, this crosstalk underpins the pathogenesis of eosinophilic asthma and chronic rhinosinusitis with nasal polyps (CRSwNP), in part via eosinophil-derived mediators that disrupt tight junction integrity and fuel remodeling. In the GI tract, homeostatic eosinophils support villous architecture, epithelial turnover, and goblet cell differentiation through microbiota-driven IL-33 signals and neuropeptide-mediated neuroimmune pathways, whereas dysregulated crosstalk promotes eosinophilic esophagitis (EoE) and inflammatory bowel disease (IBD). This review synthesizes recent research to delineate the molecular mechanisms of eosinophil–epithelial crosstalk across mucosal compartments, highlight tissue-specific differences and shared mechanistic themes, and discuss the implications of these findings for targeted therapy. Full article

Background and Clinical Significance: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disorder characterized by esophageal dysfunction and dense eosinophilic infiltration. EoE frequently evolves into a fibrostenotic phenotype, in which uncontrolled inflammation drives progressive tissue remodeling. This evolution increases the risk of complex structural complications—most commonly fixed rings and strictures, and, in rare advanced cases, deep mural injury or fistulization—substantially increasing both diagnostic and therapeutic complexity. Case Presentation: This report describes an uncommon presentation of EoE complicated by a blind-ending esophageal fistula, managed successfully through a multidisciplinary strategy integrating pharmacologic therapy, dietary modification, and endoscopic intervention. Conclusions: Nutritional support through gastrostomy, combined with multidisciplinary medical and endoscopic management, can lead to favorable outcomes in EoE complicated by esophageal fistula. Early recognition and individualized management are essential to optimize outcomes. Full article

Background: Studies on the clinical presentation of eosinophilic esophagitis and its outcome in children in the Middle East and North African region are scarce. The aim of this 10-year retrospective study was to describe the common clinical manifestations, endoscopic and histological findings, and the response to medication and dietary intervention in children and adolescents with eosinophilic esophagitis. Methods: This study was a retrospective chart review of patients aged 6 months to 18 years who attended the Pediatric Gastroenterology clinic at the American University of Beirut Medical Center between 1 January 2013 and 30 June 2023 and who were diagnosed with eosinophilic esophagitis. Results: A total of 15 patients met the inclusion criteria. The median age at diagnosis was 9 years. Male patients accounted for 73% of our cohort. The most frequent presenting symptoms were dysphagia (80%) and choking (47%). The esophagus appeared normal in 33% of subjects despite histologic confirmation of disease, highlighting the importance of routine biopsies. Adherence to therapy was variable, with 73% of subjects reporting symptom improvement following initial therapy, even in cases where histology remained active. This pattern suggests that symptomatic improvement alone may not reliably reflect disease control and underscores the importance of objective monitoring through follow-up biopsy. Conclusions: The recognition of manifestations of eosinophilic esophagitis in children, early diagnosis, and strict adherence to the diet and medication are essential to prevent long-term complications. In a resource-constrained country like Lebanon, the management remains challenging in view of the burden of dietary restrictions and high cost of procedures and biologics. Socioeconomic feasibility and long-term adherence to diet and medication is as critical as pharmacologic efficacy in determining outcomes in pediatric patients. Full article

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 (ImmunoCAP^TM 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

Eosinophilic esophagitis (EoE) is a chronic, food-driven inflammatory disorder of the esophagus in which repeated exposure to dietary antigens plays a central role, yet identification of clinically relevant food triggers remains largely empirical. In this retrospective, single-center study, molecular IgE sensitization profiles were descriptively characterized in adult patients with EoE (n = 22) and compared with an allergic control group with chronic urticaria (CU; n = 29) using component-resolved diagnostics. IgE sensitization was common in both cohorts and predominantly reflected inhalant-related, cross-reactive components, particularly PR-10 proteins (63.6% in EoE vs. 37.9% in CU). In contrast, sensitization to structurally stable food allergen components, including lipid transfer proteins and plant storage proteins, was observed in a subset of patients with EoE (31.8%) and was not detected in the control group (0%; p = 0.0015). These food-derived components are characterized by resistance to thermal processing and gastrointestinal digestion and may reflect patterns of sustained dietary exposure rather than acute IgE-mediated reactions. Consistent with previous observations, component-resolved diagnostics showed limited utility for the direct identification of trigger foods in eosinophilic esophagitis. Accordingly, the observed molecular sensitization patterns should be interpreted as descriptive and hypothesis-generating signals rather than as indicators of pathogenic mechanisms or clinical decision-making tools. The findings highlight the importance of considering molecular properties of food allergen components when interpreting sensitization profiles in chronic, non-IgE-mediated inflammatory diseases and underscore the need for prospective studies integrating standardized clinical and dietary outcomes. Full article

Mucins are high-molecular-weight glycoproteins that form the main structural component of the mucus covering epithelial surfaces in the gastrointestinal, respiratory, and urogenital tracts. They support epithelial integrity by protecting against microbial invasion, dehydration, and mechanical or chemical insults, while facilitating the transit of luminal contents. Beyond their structural function, mucins play key roles in molecular recognition. Their extensive glycosylation enables interactions with a wide range of molecules and allows the discrimination between pathogenic and commensal microorganisms at mucosal surfaces. Mucins help maintain mucosal homeostasis by preventing pathogen adhesion and colonization, while simultaneously providing nutrients to commensal species, supporting their stability, and maintaining spatial segregation from epithelial surfaces. Aberrant expression of mucin subtypes or alterations in their glycosylation patterns are associated with numerous diseases, including a wide spectrum of cancers and inflammatory disorders. The immunological relevance of the esophageal mucosa has only recently been recognized. Advances in the study of the esophageal mucosa-associated immune surveillance system and its interactions with structural components of this organ’s surface, including mucins, have shed light on unique pathological processes in the esophagus, such as Barrett’s esophagus, gastroesophageal reflux disease, and eosinophilic esophagitis. This review focuses on the role of esophageal mucins in inflammation, compiling current evidence to provide an integrated overview of mucin-driven inflammatory mechanisms. Full article

Background: Eosinophilic esophagitis (EoE) is a chronic, food antigen-driven disease of the esophagus that causes considerable morbidity. Elimination of allergenic foods from a patient’s diet is a highly effective treatment. However, existing allergen testing modalities are not effective at identifying EoE-causal foods. We sought to determine the extent to which positive results for two functional T-cell assays, the EoE Milk Test and EoE Soy Test, associated with the clinical outcomes of EoE milk allergy and EoE soy allergy, respectively. Methods: Subjects were enrolled into one of two study designs: a prospective observational study or a retrospective case/control study. Additional control samples were obtained from an institutional core. The EoE Milk and Soy Tests were performed on peripheral blood samples, and the association between positive tests and clinical outcomes was determined using Receiver Operating Characteristic curves and other performance measures. Results: The EoE Milk Test maintained reliability regardless of disease activity or recent milk consumption and had 87% sensitivity and 83% specificity for EoE milk allergy in all study subjects (control and EoE). The EoE Soy Test had 90% sensitivity and 93% specificity in all subjects. Conclusions: Our evaluation of the EoE Milk and Soy Tests demonstrates that these functional T-cell assays hold promise as a predictive tool for identifying causal allergens in eosinophilic esophagitis patients. Full article

Eosinophilic esophagitis (EoE) is a chronic, allergic, immune-mediated inflammation of the esophagus caused by food antigens. The prevalence in pediatric population is approximately 34 to 57 cases per 100,000 children, with a male to female ration 3:1. This number may be underestimated due to diagnostic challenges and variety of clinical presentations in different age groups. Diagnosis of EoE requires histopathological assessment of esophageal biopsies retrieved during gastroscopy, with at least 15 eosinophils per high-power field (HPF) in the esophageal tissue being the cut off value. According to recommendations, treatment options of EoE include dietary interventions (elimination diets), medical treatment (inhibitors of proton pump, steroids, biologics), and in some cases surgical intervention (dilation). Dietary intervention, such as elimination diets, target the triggering factors of the disease and, if supervised by professional nutritionist, have the least systemic side effects. On the other hand, depending on the number of allergens eliminated from the pediatric patients’ diet, the quality of life both of the child and their caretakers may be compromised. Additional challenges such as nutritional risks, feeding disorders, financial burden, and social life impairment also have to be taken into consideration. On top of this, an effectiveness assessment of chosen therapy requires repeated endoscopic examination with several biopsies of the esophagus, further increasing diseases burden in EoE patients. Taking all of this factors into consideration, the main objective of this narrative review was to address challenges that pediatric patients with EoE on dietary treatment face with reference to current research and daily practice. Full article

Eosinophilic esophagitis (EoE) has emerged as a major cause of dysphagia and food impaction worldwide. This narrative review traces the evolving therapeutic pipeline for EoE, highlighting agents spanning from late-stage clinical development to final approval. We summarize mechanistic insights that have driven a shift from broad immunosuppression to precise inhibition of type-2 inflammatory pathways, including blockade of key interleukin pathways. Randomized trials have demonstrated histologic and symptomatic gains, yet regulatory approvals and optimal positioning within treatment algorithms are pending. Parallel innovations in drug delivery aim to maximize mucosal exposure while minimizing systemic burden. Key challenges include heterogeneity in disease phenotype, paucity of long-term safety data, and the need for non-invasive biomarkers to guide precision prescribing. Cost considerations and patient preferences will shape adoption. By integrating advances across immunology, formulation science and clinical trial design, the therapeutic pipeline for EoE holds promise to transform care from empirical suppression to mechanism-based disease modification. Full article

Eosinophilic esophagitis (EoE) is an emerging disease characterized by chronic inflammation of the esophagus. EoE is a multifactorial disorder, likely resulting from the combination of genetic predisposition, epithelial barrier dysfunction, environmental risk factors, and allergen sensitization, which lead to type 2 inflammation of the esophagus. The clinical manifestations are related to esophageal dysfunction and include dysphagia, food impaction, heartburn, regurgitation, and food refusal. These symptoms are sometimes superimposable and can often be confused with the symptoms of gastroesophageal reflux disease. To-date, EoE diagnosis relies on endoscopic examination and histological analysis of esophageal biopsies, with the diagnostic criterion defined as the presence of ≥15 eosinophils per high-power field (eos/HPF). As a result, both the diagnostic and the subsequent disease monitoring processes, including assessment of treatment, efficacy, and remission status, require repeated endoscopic procedures. These procedures are rather invasive for patients, particularly in the pediatric population, and impose a significant financial strain on healthcare systems. Therefore, in recent years, substantial efforts have been made to identify novel non-invasive or minimally invasive biomarkers. This review aims at synthesizing the current findings and at categorizing the most promising biomarkers according to the different biological sources to ultimately enable earlier detection, reduce patient discomfort, and guide personalized treatment strategies. Full article