Eosinophilic esophagitis: pathophysiology and optimal management.

Eosinophilic esophagitis (EoE) is an increasingly recognized disease characterized by esophageal symptoms accompanied by increased esophageal mucosal eosinophilia. The reasons for the increasing prevalence and understanding of the pathogenesis of EoE are areas of active investigation. Food and environmental allergy, host immunologic predisposition, and interactions with gastroesophageal reflux disease have emerged as important aspects of the disease. The optimal management of EoE is controversial and evolving. Therapeutic options include medical therapy with acid suppression, corticosteroids, and biologic agents. Elimination diets and endoscopic esophageal dilation have shown effectiveness. Management strategies for individual patients range from clinical observation to multimodal therapy, depending on the clinical presentation.