13 May 2026
Eosinophilic gastrointestinal diseases (EGIDs) are divided into two main groups: eosinophilic esophagitis (EoE) and eosinophilic gastroenteropathies (EGEs). Eosinophilic Esophagitis (EoE) is the most common form of EGID.
In recent years, interest and research into these conditions have grown exponentially, prompting institutions and organizations to devote more resources and attention to raising awareness and providing assistance and support to those affected. In this article, we will provide a comprehensive overview of what Eosinophilic Esophagitis is, its symptoms, diagnosis, regular monitoring, and the treatments currently available.
What is Eosinophilic Esophagitis?
Eosinophilic Esophagitis is a chronic inflammatory disease of the esophagus characterized by the accumulation of eosinophils, a type of white blood cell, within the esophageal tissue. This reaction is often the immune system’s response to food or environmental allergens, which cause inflammation of the esophageal tissues and lead to a range of troublesome symptoms for people affected by this condition.
Diagnosis
The diagnosis of Eosinophilic Esophagitis requires a thorough assessment. Usually, the first step includes taking a medical history and performing a physical examination, followed by more specific tests such as endoscopy with biopsy. During the endoscopy, the doctor examines the inside of the esophagus and collects tissue samples to check for the presence of eosinophils and other signs of inflammation. From a histological perspective, EoE is characterized by mucosal eosinophilia and symptoms secondary to esophageal dysfunction.
The endoscopic features of EoE include the presence of acute proximal, middle, or distal esophagitis, with signs such as erythema, edema, mucosal friability, whitish spots (eosinophilic microabscesses), and signs of chronic esophagitis such as esophageal rings, longitudinal furrows, and esophageal strictures. However, these abnormalities are not exclusive to EoE, as they may also be found in other forms of esophagitis; therefore, histological analysis is necessary to confirm the diagnosis.
Symptoms
This disease presents with different symptoms depending on the patient’s age. In younger patients, it mainly manifests through impaired esophageal motility: food and water have difficulty reaching the stomach or, in advanced stages, may stop above the cardia, located between the esophagus and the stomach, causing food regurgitation. In adults, esophageal fibrosis is often reported.
In young children, common symptoms include growth delay and feeding difficulties, such as difficulty introducing solid foods or refusal of certain foods, as well as nonspecific symptoms of gastroesophageal reflux. Older children may experience abdominal pain and recurrent vomiting, while young adults often present with dysphagia and esophageal obstruction caused by a food bolus. Dysphagia may worsen with age and disease duration and, in some cases, may be the first evident symptom.
Available Treatments
The treatment of EoE aims to reduce inflammation, relieve symptoms, and prevent long-term damage to the esophagus. Therapeutic options include dietary and pharmacological interventions, such as proton pump inhibitors (PPIs) and topical steroids, used either individually or in combination, depending on the patient’s response.
Nutritional therapies include:
- Elemental diet: based on amino acid formulas, this approach has shown high effectiveness in inducing disease remission. However, due to its highly restrictive nature, it may negatively affect quality of life and is not sustainable in the long term.
- Empirical diet: this diet involves eliminating six main food groups: milk, soy, eggs, wheat, peanuts/tree nuts, and fish. This is because milk, egg, and wheat proteins are frequently involved in the pathogenesis of the disease.
Proton pump inhibitors such as esomeprazole, omeprazole, lansoprazole, and pantoprazole are often prescribed to patients with EoE because they also have an anti-inflammatory effect. They are particularly indicated in cases with symptoms of gastroesophageal reflux and are administered for a period of at least 8 weeks.
Steroid therapy, which is extremely effective in most patients, is mainly topical and includes medications such as oral viscous budesonide or swallowed fluticasone dipropionate. These treatments are generally recommended for a minimum period of 3 months. Systemic steroid therapy, such as prednisone or methylprednisolone, is reserved for patients with severe symptoms, such as esophageal strictures, and usually does not exceed 14 days of treatment.
New Available Treatments: Monoclonal Antibody Therapy
Emerging treatments for eosinophilic esophagitis also include monoclonal antibodies, a type of biological therapy aimed at modulating the immune system.
Monoclonal antibodies work by binding specifically to certain molecules involved in inflammatory processes, such as cytokines, which are critical factors in the induction and maintenance of eosinophilic esophagitis. This binding prevents cytokines from interacting with their target cells, thereby reducing inflammation and the symptoms associated with the disease.
It is important to note that, as with any treatment, monoclonal antibodies may have side effects and not all patients may be candidates for this therapy. Therefore, a thorough assessment by a specialist physician is essential. The specialist will consider the patient’s clinical history and the specific characteristics of the disease in order to determine the most appropriate therapeutic strategy.
This therapeutic option is currently about to be placed on the market, and we are awaiting price determination through negotiations with AIFA.
The Role of ESEO Italia
Organizations such as ESEO Italia play a crucial role in offering support to patients and their families by providing reliable information through awareness campaigns, events, and conferences, and by promoting research and healthcare dedicated to Eosinophilic Esophagitis. Through awareness-raising and assistance, ESEO Italia aims to improve the quality of life of people affected by this condition and to promote greater understanding of the disease among healthcare professionals and the general public.
