Eosinophilic esophagitis: From pathophysiology to diagnosis, monitoring and treatment

BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disorder of the oesophagus that has transformed from a rarely recognized condition to one of the most common causes of dysphagia and food impaction in children and young adults. This review provides a comprehensive, clinically oriented overview of EoE for the practicing clinician. METHODS: We conducted a narrative review focusing on systematic reviews, meta-analyses, randomized controlled trials and international guidelines published through 2025. RESULTS: EoE pathogenesis involves genetic susceptibility, environmental triggers, epithelial barrier dysfunction and type 2 immune activation. Diagnosis requires clinical symptoms, endoscopic findings and histologic confirmation of ≥15 eosinophils per high-power field. Treatment options include proton pump inhibitors (histologic remission ~45%), swallowed topical corticosteroids (~80%-93%), dietary elimination strategies (~60%) and dupilumab (~60%). Without treatment, EoE progresses from inflammatory to fibrostenotic disease, with stricture risk increasing approximately 5% per year of undiagnosed disease. CONCLUSIONS: EoE management requires integration of clinical, endoscopic and histologic assessments. Current treatments effectively induce remission in most patients. Future priorities include developing non-invasive monitoring tools and identifying predictors of treatment response.