Eosinophilic Esophagitis: Leaky Gullet or Leaky Gut?

Eosinophilic esophagitis (EoE) is a food allergen disorder driven by antigen recognition in the gastrointestinal tract. The study by Warners et al., strongly supports the esophageal epithelium as the area of disturbed permeability and primary target for initiation of the TH2-induced allergic pathway. In contrast, small bowel assessment reveals a lack of clear change in aspects of permeability compared to controls. It is not clear, however, if the available testing used for this purpose accurately assesses the mechanisms by which antigen recognition may occur in this organ. As a result, the role of the small bowel in EoE remains unclear.