Search Results (171)

Background: Orodispersible budesonide tablets (OBTs, Jorveza) are approved by the EMA as a therapy option in eosinophilic esophagitis (EoE) in adults. However, data on their use in pediatric patients remain limited and no approved pediatric OBT formulation is currently available in Europe. Therefore, real-world data on off-label use of OBTs in children is needed. Methods: We retrospectively analyzed data on the off-label use of OBTs in eight children (five girls) at a median age of 10.5 years (ranging from 5 to 14). Clinical, histological and safety outcomes were assessed descriptively. Results: Treatment with OBTs was associated with clinical improvement and a reduction in eosinophil counts. Specifically, the median eosinophil count decreased from 38.5 (ranging from 20 to 100) to 0 (ranging from 0 to 20) eosinophils per high-power field. Histological remission, defined as <15 eosinophils per high-power field, was achieved in six of eight patients (75%). Clinical remission was reached in seven of eight patients (87.5%). No severe side effects could be detected. Conclusions: OBTs showed promising clinical and histological responses in this small retrospective pediatric case series. However, larger prospective studies are required before efficacy and safety can be established. Further clinical studies are needed to assess whether OBTs could become an approved pediatric therapy. Full article

Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease that is increasingly recognized as a systemic inflammatory condition. Its potential association with subsequent coded ocular diagnoses has not been well characterized in large-scale longitudinal studies. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, which aggregates de-identified electronic health records from multiple international healthcare systems. Adults aged ≥18 years with at least two clinical encounters between 2005 and 2024 were included. Patients with EoE (ICD-10-CM K20.0) were identified as the exposure cohort, while individuals undergoing routine health examinations without EoE served as controls. Those with prior ocular disease, malignancy, or death were excluded. Propensity score matching (1:1) was used to balance demographics, body mass index, comorbidities, medication use, and socioeconomic factors. The primary outcomes were coded ocular diagnostic categories identified using ICD-10-CM codes. To reduce the likelihood of including pre-existing conditions, ocular disease events diagnosed within 3 months after the index date were excluded from the analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated. Sensitivity analyses incorporated alternative exposure definitions, washout periods, and follow-up durations, with additional stratification by age, sex, and race. Results: After matching, 64,613 patients were included in each cohort. EoE diagnostic coding was associated with a higher subsequent occurrence of several coded ocular diagnostic categories, including visual disturbance and blindness (HR = 1.521; 95% CI: 1.383–1.673), disorders of refraction and accommodation (HR = 1.324; 95% CI: 1.188–1.474), lacrimal system disorders (HR = 1.504; 95% CI: 1.274–1.775), cataract (HR = 1.637; 95% CI: 1.384–1.935), glaucoma (HR = 1.463; 95% CI: 1.157–1.849), and disorders of the vitreous body and globe (HR = 1.903; 95% CI: 1.510–2.399). These findings should be interpreted cautiously because several outcomes, such as visual disturbance, disorders of refraction and accommodation, and ocular pain, were broad diagnostic categories and may be susceptible to detection or coding practices. Conclusions: In this large-scale EHR-based cohort study, EoE diagnostic coding was associated with a higher subsequent occurrence of several coded ocular diagnostic categories. These findings should be interpreted as exploratory associations rather than evidence of direct causal or mechanistic relationships, particularly for broad or detection-prone outcomes such as visual disturbance, disorders of refraction and accommodation, and ocular pain. Full article

Background/Objectives: This study evaluates the clinical presentation and treatment outcomes of esophageal eosinophilia (EE) in patients with inflammatory bowel disease (IBD). It compares outcomes based on the timing of diagnosis (simultaneous vs. EE after IBD diagnosis) and treatment (treated vs. untreated EE). Methods: This retrospective cohort study included patients ≤ 22 years with IBD and EE (≥15 eosinophils/high-powered field {eos/HPF}) between July 2017 and December 2023. Clinical, endoscopic, histologic, and EE treatment data were collected. EE histologic remission defined as <15 eos/HPF was assessed on repeat esophagogastroduodenoscopy (EGD). Groups were compared using standard statistical tests, with p < 0.05 considered significant. Results: Of fifty-six patients with IBD and EE, thirteen (23%) were diagnosed with EE and IBD simultaneously and forty-three (77%) patients were diagnosed with EE after IBD. Most were diagnosed with EE incidentally. Esophageal symptoms and histologic findings between patients diagnosed simultaneously vs. EE after IBD were similar. Among patients treated for EE (n = 28) and those who were untreated (n = 28), there were significant differences in esophageal symptoms (54% vs. 0%; p < 0.01) and median esophageal eosinophil count (30 vs. 22 eos/HPF; p = 0.003). However, among patients with a repeat EGD, EE histologic remission rates were similar between those who were treated vs. untreated (35% vs. 47%; p = 0.5). Conclusions: We found that for patients with both IBD and EE, most were diagnosed incidentally with EE after IBD diagnosis. The observation of spontaneous histologic esophageal remission in a subset of patients suggests that incidental EE in patients with IBD may not always represent eosinophilic esophagitis (EoE) and should not automatically lead to a lifelong diagnosis. Full article

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized by eosinophilic infiltration, epithelial barrier dysfunction, and progressive tissue remodeling. Increasing evidence identifies eosinophils as central drivers of inflammation and fibrosis, linking EoE to type 2 immune responses and allergic disorders. However, the molecular mechanisms underlying eosinophil-mediated esophageal damage and their interaction with gastroesophageal reflux disease (GERD) remain incompletely understood. Material and Methods: A comprehensive narrative review of the current literature was conducted, focusing on studies investigating eosinophil biology, inflammatory signaling pathways, epithelial remodeling, fibrosis, and therapeutic targets in EoE. Clinical, translational, and experimental studies evaluating the association between EoE, GERD, and allergic comorbidities were critically analyzed. Results: Available evidence demonstrates that eosinophils actively contribute to EoE pathogenesis through the release of cytotoxic granule proteins, cytokines, chemokines, and lipid mediators, leading to chronic inflammation and fibrostenotic remodeling. Dysregulation of type 2 cytokines, particularly IL-4, IL-5, and IL-13, plays a pivotal role in disease progression and immune cell recruitment. Significant overlap between EoE and GERD suggests shared inflammatory mechanisms and diagnostic challenges. Furthermore, EoE frequently coexists with systemic allergic diseases, supporting the concept of a broader atopic inflammatory phenotype. Emerging biologic therapies targeting eosinophilic and type 2 inflammatory pathways have shown promising efficacy in reducing symptoms and histologic activity. Conclusions: Eosinophils represent key regulators of EoE pathobiology and constitute promising biomarkers and therapeutic targets. A deeper understanding of eosinophil-driven inflammatory networks may improve diagnostic accuracy, patient stratification, and the development of personalized therapeutic strategies for EoE and related esophageal inflammatory disorders. Full article

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