Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory condition of the esophagus characterized by eosinophilic infiltration, and hallmark symptoms of esophageal dysfunction such as dysphagia and food impaction. Over the past three decades, EoE has been recognized as a distinct clinical entity, distinguished from gastroesophageal reflux disease (GERD) through advancements in diagnostic techniques, particularly endoscopy with biopsy. The rising global prevalence of EoE reflects enhanced diagnostic awareness, evolving criteria, and environmental along with lifestyle changes. The etiology of EoE is multifactorial, involving genetic predispositions, immune dysregulation, the gut microbiome, and environmental triggers, including dietary allergens and aeroallergens. Key mechanisms include a type 2 helper T-cell (Th2)-driven immune response, epithelial barrier dysfunction, and genetic variants such as CAPN14 and TSLP. Chronic inflammation leads to tissue remodeling, fibrosis, and esophageal narrowing, contributing to disease progression and complications. Management strategies have evolved to include dietary elimination, proton pump inhibitors, topical corticosteroids, biologics, and endoscopic interventions for fibrostenotic complications. Emerging therapies targeting cytokines such as interleukin (IL)-4, IL-5, and IL-13, alongside novel diagnostic tools like the esophageal string test and Cytosponge, offer promising avenues for improved disease control and non-invasive monitoring. Long-term surveillance combining endoscopic and histological evaluations with biomarkers and non-invasive tools is critical to optimizing outcomes and preventing complications. Future research should address gaps in understanding the role of the esophageal microbiome, refine therapeutic approaches, and develop personalized strategies to improve disease management and patient quality of life.

The impact of advanced age on esophageal motility remains relatively underexplored, particularly using updated diagnostic protocols. To evaluate esophageal motility findings, indications, success rate, and diagnostic yields of high-resolution manometry (HRM) in elderly patients. A retrospective multicenter study was conducted across six tertiary medical centers of adult patients undergoing HRM between 2022 and 2024. The indications, success rate, diagnostic yield, and HRM metrics were compared according to the novel definition of elderly (≥75 years old). 1146 patients were included (275 ≥ 75 years and 871 < 75 years). Dysphagia was the most common indication among elderly patients (≥75 years: 69.0 % vs. <75 years: 45.2 %, p < 0.001). The success rate of HRM was similar (91.7 % vs. 90.0 %, p = 0.575). Elderly patients exhibited higher rates of type III achalasia (6.1 % vs. 1.2 %, p < 0.001), esophagogastric junction (EGJ) outflow obstruction (13.6 % vs. 3.1 %, p < 0.001), and hypercontractile esophagus (5.3 % vs. 2.5 %, p < 0.001). Diagnostic yield increased with age for any motility disorder (p = 0.016) and Disorders of EGJ Outflow (p < 0.001). For any motility disorder, the prevalence increased from 45.7 % (<65 years) to 48.9 % (65-74 years) to 56.0 % (≥75 years)(p = 0.016). There is a higher prevalence of motility disorders observed in older populations, especially after age 75, supporting the relevance of the novel definition of elderly.

Epstein-Barr virus (EBV) is a common human Herpesvirus with worldwide distribution. Primary EBV infection usually occurs early in life and typically presents as infectious mononucleosis consisting of fever, pharyngitis, hepatosplenomegaly, and lymphadenopathy. Usually, the disease course is benign and most patients recover uneventfully without any consequent sequel. We present a case of an immunologically normal young male in whom an acute EBV infection caused severe pneumonitis. He was treated empirically with Paracetamol, intravenous Ceftriaxone 1 gr/day plus Azithromycin 500 mg/day. EBV-associated pneumonitis is rare, and treatment is usually supportive, whether antiviral agents (such as acyclovir) or steroids would be beneficial remains to be determined.

Background/Objectives: Eosinophilic esophagitis (EoE) is an increasingly recognized chronic immune-mediated inflammatory disease of the esophagus. Data on the real-world diagnosis and management practices among gastroenterologists in Israel is scarce. This study aimed to describe current diagnostic and treatment practice patterns for eosinophilic esophagitis among Israeli gastroenterologists, and to identify areas of concordance with, and variability relative to, international recommendations. Methods: A nationwide, cross-sectional, internet-based survey was conducted among gastroenterologists from the Israeli Gastroenterology Association (IGA) and the Israeli Society of Pediatric Gastroenterology, Hepatology and Nutrition between February and April 2024. We used a structured 28-item questionnaire covering physician demographics, diagnostic practices and treatment strategies of EoE. Responses were analyzed for the entire cohort and compared across subgroups based on physician characteristics. Results: Of the 540 eligible gastroenterologists, 114 (22%) completed the survey. Almost all responders (97%) would obtain esophageal biopsies in the case of dysphagia even without typical endoscopic findings. Similarly, 94% of the responders would obtain esophageal biopsies in the case of typical endoscopic findings even without dysphagia. About 86 (75%) were familiar with the Endoscopic Reference Score (EREFS) system. Proton pump inhibitors were the most prescribed first-line treatment (92%), followed by dietary interventions (40%) and topical steroids (17%). As compared with adult gastroenterologists, pediatric gastroenterologists were more likely to obtain biopsies, use the EREFS and initiate treatment before histologic confirmation was obtained. Overall, practices showed broad concordance with international recommendations (>75% of respondents). Conclusions: In this cross-sectional survey, it was demonstrated that diagnostic and treatment practices for EoE among Israeli gastroenterologists were broadly concordant with international recommendations. However, several areas of inconsistency across different provider subgroups were identified. These gaps can be managed through educational programs that will improve standardization of management in EoE.

Purpose: Data on Eosinophilic esophagitis in Israel is sparse. We appraised the clinical, endoscopic, and histological characteristics of 50 Israeli adults with EoE. Methods: Medical records of 50 adult patients with established diagnoses of EoE who were referred to our center from 2020 until 2023 at Bnai Zion Medical Center, Haifa, Israel, were reviewed. Results: Fifty patients with EoE were included, the mean age at diagnosis was 34±9.5 years. The sex ratio of males to females was approximately 2:1 with 34 males (68%) and 16 females (32%). Twenty-two of the 50 patients had a history of allergic diseases, Symptoms at diagnosis were as follows: Dysphagia was the primary presenting symptom observed (n=25, 50%), followed by food impaction (n=17, 34%) and GERD-like symptoms (n=14, 28%). Less frequent symptoms included vomiting, nausea, and chest pain. The most common endoscopic findings were normal mucosa (n=21, 42%) followed by Trachealization (n=17, 34%), esophagitis (n=7, 14%), and exudates (n=5, 10%). 66% of the subjects were initially treated with proton-pump inhibitors (PPIs). Nine patients (18%) were asymptomatic without any treatment. The remaining eight patients (16%) were given topical steroids. Clinical and histological resolution was detected in 50% of the patients who underwent a second EGD after 6–8 weeks of PPI. Conclusion: Our current study depicts the clinical features of adult patients with EoE in north Israel. This is the first demographic study in Israel that defines the clinical, endoscopic, and histological manifestations of EoE in the adult population.