Recent research advances in eosinophilic esophagitis.

PURPOSE OF REVIEW: Eosinophilic esophagitis (EoE) is a chronic allergic disease triggered by food allergens with an increasing prevalence. This review highlights recent research advances in EoE with a focus on the literature of the past 18 months.

RECENT FINDINGS: The incidence of EoE in the black population is higher than previously suggested. A novel locus spanning CAPN14 is associated with EoE. Diagnostic tests utilizing an analysis of EoE-specific transcriptome have been improved. Standardized EoE symptom score systems have been established. Treatment trials show the promise and limitations of allergen avoidance, antiinflammatory reagents, and anti-interleukin-13 antibodies. Insights into disease mechanisms highlight the role of invariant natural killer T cells and group 2 innate immune cells. Epithelial barrier protein desmoglein 1, bone morphogenetic protein antagonist follistatin, neurotrophic tyrosine kinase receptor type 1, and CAPN14 have been defined as new potential therapeutic targets in EoE as regulators of the inflammatory interleukin-13-axis. The role of IgG4 in the disease mechanisms has been suggested.

SUMMARY: Genetic predisposition influenced by environmental factors increases EoE susceptibility. Research identifying the critical events leading to allergen sensitization and the esophagus-specific responses that drive EoE is evolving, and will lead to a better understanding of EoE and new therapeutic approaches for the disease.