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.

Eosinophilic esophagitis (EoE) has emerged as a major cause of dysphagia and food impaction worldwide. This narrative review traces the evolving therapeutic pipeline for EoE, highlighting agents spanning from late-stage clinical development to final approval. We summarize mechanistic insights that have driven a shift from broad immunosuppression to precise inhibition of type-2 inflammatory pathways, including blockade of key interleukin pathways. Randomized trials have demonstrated histologic and symptomatic gains, yet regulatory approvals and optimal positioning within treatment algorithms are pending. Parallel innovations in drug delivery aim to maximize mucosal exposure while minimizing systemic burden. Key challenges include heterogeneity in disease phenotype, paucity of long-term safety data, and the need for non-invasive biomarkers to guide precision prescribing. Cost considerations and patient preferences will shape adoption. By integrating advances across immunology, formulation science and clinical trial design, the therapeutic pipeline for EoE holds promise to transform care from empirical suppression to mechanism-based disease modification.

Esophageal symptoms, including dysphagia, heartburn, and non-cardiac chest pain, are prevalent concerns in gastroenterology. This review examines the roles of advanced diagnostic modalities such as high-resolution manometry (HRM), pH-impedance monitoring, and EndoFLIP in understanding esophageal physiology and pathology. Here, we discuss the clinical presentations of common esophageal symptoms and explore how structural abnormalities like strictures and motility disorders, including achalasia and esophageal spasms, are assessed using these tools. The diagnostic utility of endoscopy in visualizing mucosal and structural changes is highlighted alongside emerging technologies like artificial intelligence in enhancing detection capabilities. Complementary techniques, such as barium esophagrams and reflux monitoring, provide additional functional and anatomical insights, crucial for comprehensive patient evaluation. The integration of these diagnostic approaches fosters a deeper understanding of esophageal disorders, guiding effective management strategies and improving patient outcomes. This review aimed to highlight the importance of adopting a multimodal diagnostic approach in modern gastroenterological practice.