Eosinophilic esophagitis: When to suspect and why to treat with proton pump inhibitors

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease driven by food allergens that manifests with symptoms of esophageal dysfunction and eosinophil-predominate esophageal inflammation. Since the early 1990s, the frequency of EoE has exploded for unclear reasons. Treatment of EoE with diet therapy or topical steroids, which are potent anti-inflammatory agents, makes sense for management of an allergic condition triggered by food antigens. Recent consensus guidelines now include proton pump inhibitor therapy as an alternative first-line treatment. This review will provide an overview of when to suspect and how to diagnosis EoE, concepts surrounding pathogenesis and increasing incidence of this newly recognized esophageal condition, and a discussion on why proton pump inhibitors are now being used as a first-line treatment strategy.