Red Between the Lines: Evolution of Eosinophilic Esophagitis as a Distinct Clinicopathologic Syndrome
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Red Between the Lines: Evolution of Eosinophilic Esophagitis as a Distinct Clinicopathologic Syndrome Evan S. Dellon1 Accepted: 25 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophageal mucosa and symptoms of esophageal dysfunction, including dysphagia. While EoE is still considered a rare disease, in practice it seems that more and more cases are diagnosed every week, research in the field is exploding, and the pipeline for treatments contains multiple agents, some of which are quite far along the development pathway. After only scattered cases and small series were published in the late 1970s and 1980, Stephen Attwood, Thomas Smyrk, Tom DeMeester, and James Jones, published in Digestive Diseases and Sciences in 1993 a seminal report that described a clinicopathologic syndrome of esophageal eosinophilia with dysphagia. This review details the origins of this paper and compares and contrast what was observed then and what is known now about multiple aspects of EoE, including the clinical presentation, diagnosis, epidemiology, natural history, and treatments and outcomes. Moreover, it will highlight how the paper presaged a number of controversies in the field that have yet to be resolved, as well as foreshadowed the collaborative, multidisciplinary approach that has led to rapid advances. Keywords Eosinophilic esophagitis · Clinicopathologic · Histology · Diagnosis · Treatment · Controversies
Introduction: EoE Before 1990 Eosinophilic esophagitis (EoE) is a disease characterized by eosinophilic infiltration and characteristic macroscopic changes of the esophageal mucosa accompanied by dyspha‑ gia. Now widely recognized by gastroenterologists and aller‑ gists, EoE has rapidly become a major cause of upper gas‑ trointestinal morbidity [1, 2]. While still considered a rare disease [3], in practice it seems that more and more cases are diagnosed every week, research in the field is exploding, and the pipeline for treatments contains multiple agents, some of which are quite far along the development pathway [4]. As dynamic as is the current interest in the disease, this was not always the case as substantial progress has been made over the last 30–40 years.
* Evan S. Dellon [email protected] 1
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., UNC‑CH, Chapel Hill, NC 27599‑7080, USA
The first cases of EoE were described in single patient reports of Dobbins and Landres in the late 1970s [5, 6]. The paper by Dobbins described a patient with eosinophilic gastroenteritis who had esophageal involvement with eosino‑ philia and symptoms of dysphagia in the setting of concomi‑ tant atopy. In contrast, the paper by Landres related a case of eosinophilic esophagitis in the setting of vigorous achalasia. This patient had soli
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