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. 2019 Oct;54(10):837-844.
doi: 10.1007/s00535-019-01604-7. Epub 2019 Jul 24.

Eosinophilic Esophagitis: Novel Concepts Regarding Pathogenesis and Clinical Manifestations

Free PMC article

Eosinophilic Esophagitis: Novel Concepts Regarding Pathogenesis and Clinical Manifestations

Stuart Jon Spechler. J Gastroenterol. .
Free PMC article


This report explores two hypotheses regarding eosinophilic esophagitis (EoE): (1) that the use of proton pump inhibitors (PPIs) might contribute to the pathogenesis of EoE by preventing peptic digestion of food allergens, by increasing gastric mucosal permeability to enable gastric absorption of those undegraded food allergens, and by causing microbial dysbiosis, and (2) that EoE, like eosinophilic gastroenteritis, might have mucosal-predominant and muscle-predominant forms, and that the muscle-predominant form of EoE might cause a variety of esophageal motility disorders including achalasia.

Keywords: Achalasia; Esophageal motility; Proton pump inhibitors.

Conflict of interest statement

Dr. Spechler serves as a consultant for Ironwood Pharmaceuticals, Frazier Life Sciences, and Interpace Diagnostics.


Fig. 1
Fig. 1
Potential mechanisms underlying the association of esophageal motility abnormalities and esophageal eosinophilia. a Primary esophageal motility abnormalities cause esophageal stasis with retained material that irritates the mucosa, inducing secretion of chemokines that attract eosinophils. b Motility abnormalities are caused by eosinophils in the esophagus that release myoactive, neuroactive, and pro-fibrotic eosinophil secretory products. c Motility abnormalities are caused by eosinophils in the esophagus that release cytotoxic eosinophil secretory products that destroy esophageal intramural neurons Modified illustration of esophagus and stomach used with permission, copyright, American Gastroenterological Association Institute, Bethesda, MD, and figure reproduced from reference 27 with permission from the American Journal of Gastroenterology

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