Eosinophilic esophagitis - Risk factors, pathophysiological mechanisms, and practical aspects for diagnosis and treatment in children and adults.

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by eosinophilic infiltration and symptoms of esophageal dysfunction with rapidly increasing epidemiology. EoE represents the main cause of dysphagia and food impaction in children and young adults, with symptoms varying according to patient age. Diagnosis requires endoscopy with the taking of esophageal biopsy samples in sufficient numbers and from multiple locations, since endoscopic findings, graded according to the EREFS (edema, rings, exudates, furrows, stenosis) score, are nonspecific. Different studies have identified potential non-invasive biomarkers and methods of obtaining esophageal samples that allow dispensing with endoscopy and biopsies in both initial diagnosis and the monitoring of response to treatment. Their implementation might reduce the diagnostic delay and healthcare costs associated with EoE. First-line anti-inflammatory treatments include empirical elimination diets, proton pump inhibitors, and topical corticosteroids. Dupilumab has recently been incorporated for refractory patients. Esophageal dilation is a safe and effective option to relieve symptoms in case of stenosis. Adherence to long-term treatment and the transition from pediatric to adult services remain challenging. The efficacy of current therapies allows achieving and maintaining remission in a large proportion of patients with EoE. However, there are gaps in non-invasive diagnostic methods and long-term control. Thus, the aim of this review is to synthesize the pathophysiological bases and summarize the main advances in the diagnosis and treatment of EoE, as well as to highlight some current limitations in the care process.