Eosinophilic Esophagitis: What’s in a Name?

Excerpt

The disease and treatment target should be obvious, right? After all, it’s called eosinophilic esophagitis (EoE)! But it seems as if there’s more to that, much more, and that’s my impetus for writing this perspective. For many years, eosinophils in the esophagus were thought to be due exclusively to gastroesophageal reflux disease [1], and it wasn’t until the early 1990s when a series of publications reported what we now recognize to be EoE and demonstrated that it was likely a food allergen-driven disease [2‐4]. Prior to the first guidelines in 2007 [5], however, there were no standard criteria for the diagnosis of EoE, and the disease had many names, particularly when associated with the typical endoscopic findings. There was corrugated esophagus, trachealized esophagus, congenital esophageal stenosis, and allergic esophagitis. But on esophageal biopsy and histopathologic assessment, it was the bright magenta pink eosinophils, with their characteristic granules and deep blue bi-lobed nucleus that stood out and ultimately defined the disease. Moreover, eosinophils were known to be effector cells [6]. From their pathogenic granules to their numerous proinflammatory factors, there was ample evidence that if they were in the tissue, they could trigger the damage that led to clinical symptoms and signs in EoE. It was justified to think they were causative. …