- New observations on eosinophilic esophagitis
- Award date
- 25 January 2018
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
EoE is an increasingly recognized disorder, characterized by symptoms of esophageal dysfunction and eosinophilic infiltration of the esophagus. The incidence increased from 0.01 in 1996 to 2.07 per 100,000 inhabitants in 2015, these rates outpaces the expanding endoscopy rates. The natural course of EoE is characterized by a progression from atypical symptoms and the inflammatory endoscopic phenotype in childhood, towards symptoms of dysphagia and food impaction accompanied with the fibrostenotic phenotype in adults. If EoE is left untreated, the risk for stricture formation increased significantly.
We have demonstrated that the mucosal integrity in EoE patients with active disease is impaired compared with patients in remission and controls and that it is a promising predictor of disease activity which can be used to follow up EoE patients after treatment. In contrary to other atopic diseases the duodenal mucosal integrity is not affected in EoE.
Treatments include topical corticosteroids and dietary elimination of food allergens. In this thesis we have demonstrated that an elemental diet can induce quick histologic and clinical disease remission with improved patients’ adherence. Furthermore complete absence of food allergens restored the impaired mucosal integrity. However, diets remain cumbersome since standard allergy tests perform poorly as tools to guide elimination diets. We have demonstrated that an esophageal prick test (EPT), in which the esophageal mucosa was challenged by local allergen injections could identify sensitization patterns in EoE patients and not in controls. The EPT deserves further exploration because it may guide elimination diets. In conclusion, the studies described in this thesis have provided interesting new observations on the epidemiology, pathophysiology, diagnostics and treatment of EoE.
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