González de Béthencourt Elena, Greuter Thomas
Department of Internal Medicine, Triemli Hospital Zurich, Zurich, Switzerland.
Division of Gastroenterology and Hepatology, University Hospital Lausanne - CHUV, Lausanne, Switzerland.
Inflamm Intest Dis. 2025 Apr 29;10(1):126-134. doi: 10.1159/000546069. eCollection 2025 Jan-Dec.
Eosinophils and eosinophil infiltration are the hallmark for the diagnosis of eosinophilic esophagitis (EoE), which represents the most common cause of solid food dysphagia in young adults. However, the role of eosinophils in the pathogenesis of EoE has been increasingly questioned.
It is now well accepted that EoE is a Th2-mediated disorder with a myriad of inflammatory processes being involved rather than a single cell disease. In recent years, several nuances of EoE, so-called EoE variants, have been described, among which are EoE-like esophagitis, nonspecific esophagitis, lymphocytic esophagitis, and potentially also mast-cell esophagitis. These variants appear to have distinct molecular fingerprints sharing pronounced traits of EoE. Of note, there is a considerable flux between the variants (with frequent transitions) and eventual progression to EoE over time. Thus, EoE variants and EoE appear to be a spectrum disorder, where EoE only represents the most extreme phenotype.
This review summarizes current knowledge about these different variants and discusses future directions and open questions.
嗜酸性粒细胞和嗜酸性粒细胞浸润是诊断嗜酸性粒细胞性食管炎（EoE）的标志，EoE是年轻成年人固体食物吞咽困难最常见的原因。然而，嗜酸性粒细胞在EoE发病机制中的作用越来越受到质疑。
现在人们普遍认为，EoE是一种由Th2介导的疾病，涉及多种炎症过程，而不是单细胞疾病。近年来，已经描述了EoE的几种细微差别，即所谓的EoE变体，其中包括EoE样食管炎、非特异性食管炎、淋巴细胞性食管炎，可能还有肥大细胞性食管炎。这些变体似乎具有独特的分子特征，与EoE有明显的共同特征。值得注意的是，这些变体之间存在相当大的变化（频繁转变），并最终随着时间的推移发展为EoE。因此，EoE变体和EoE似乎是一种谱系疾病，其中EoE仅代表最极端的表型。
本综述总结了关于这些不同变体的当前知识，并讨论了未来的方向和未解决的问题。
