Beyond Eosinophils: Redefining the Spectrum of Esophageal Inflammatory Diseases Through an Immune-Centric Paradigm

Clinical Gastroenterology and Hepatology 2026 Open access

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Authors: Luisa Bertin, Andrea Pasta, Joshua B. Wechsler, Matteo Ghisa, Francesco Calabrese, Giulia Navazzotti, Federica Grillo, Luca Mastracci, Pierfrancesco Visaggi, Nicola De Bortoli, Matteo Fassan, Elisa Marabotto
+1 more Edoardo Savarino
DOI: 10.1016/j.cgh.2026.01.028
Cited by: 2
References: 68

Abstract

BACKGROUND & AIMS: Traditional classification of esophageal inflammatory diseases (EIDs) relies on predominant cell infiltrates, with eosinophilic esophagitis (EoE) defined by ≥15 eosinophils per high-power field (hpf). However, although cell count thresholds remain clinically useful for defining certain variants, this paradigm alone does not fully capture the spectrum of immune-mediated esophageal inflammation or the complexity of therapeutic responses. METHODS: We conducted a comprehensive narrative review of EID literature, emphasizing recent advances in molecular characterization, clinical phenotyping, and therapeutic approaches for classical EoE and its variants. RESULTS: Four distinct variants exist beyond classical EoE: EoE-like esophagitis (histologic EoE features with

Fields of Study & Subjects

Eosinophilic Esophagitis Esophageal Cancer Research and Treatment Gastroesophageal reflux and treatments

Publication details

Journal / source
Clinical Gastroenterology and Hepatology
Publisher
Elsevier BV
Volume
24
Issue
5
Pages
1220–1231
Publication date
11 February 2026
Language
EN