In eosinophilic esophagitis, or EoE, food and/or environmental allergens enter through an impaired esophageal epithelial barrier where they stimulate a type 2 immune response, with overexpression of the cytokines IL-4, IL-5, and IL-13, as well as chemotaxins, including eotaxin-3. Inflammatory cytokines recruit eosinophils into the esophagus where they degranulate, releasing factors that activate other inflammatory cell types, including mast cells. These cells help to perpetuate inflammation, which ultimately leads to the classic endoscopic signs and clinical symptoms of EoE. Chronic inflammation results in structural changes in the esophagus, which may include edema, rings, furrows, and exudates. If left untreated, these changes may eventually progress to esophageal fibrostenotic features, such as strictures, which can cause food impaction.
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