Eosinophilic esophagitis: New insights into an emerging disease

EoE is an increasingly common chronic allergic disease of the esophagus. Over the past 25-years, the incidence of EoE in the Netherlands has expanded a 316-fold and still continues to rise. According to consensus guidelines, if EoE is suspected, not only esophageal but also biopsy specimens from the stomach and duodenum should be sampled in order to exclude other generalized eosinophilic gastrointestinal (GI) disorders. However, we observed that gastric and duodenal biopsy specimens seem to have limited diagnostic value for the exclusion of generalized or eosinophilic GI disorders in adults with EoE. The efficacy of a new ‘combined diet strategy’ of empiric elimination of causative foods with AAF (Amino-acid based formula) added to the diet is compared to a standard FFED (Four-Food Elimination Diet) in a randomized controlled trial. The findings in this thesis could suggest that a combined dietary approach may have benefits above FFED alone in terms of improvement of patients’ quality-of-life (QoL). In addition, the findings in this thesis strongly suggests that dietary elimination in adult EoE patients is associated with a broad transcriptional response at the level of the esophageal epithelium. Mental health issues being faced by adult patients appears still to be an underexposed topic in EoE. We observed that a considerable proportion of adult EoE patients suffers from mental distress, with a striking 3-fold risk of significant anxiety being observed in those patients younger than 35-years. Moreover, less effective coping strategies are related to poor perception of general and disease specific QoL in EoE patients.