Eosinophilic Esophagitis in Asia: Distinct Clinical Phenotypes and Implications for Long-Term Management
- 1Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine Seoul Korea
- 2Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine Chapel Hill NC USA
Abstract
Eosinophilic esophagitis (EoE) has traditionally been regarded as a chronic, progressive inflammatory disorder associated with dysphagia, food impaction, and fibrostenotic remodeling. However, growing evidence from Asia suggests that EoE in Asian populations may exhibit distinct epidemiologic and clinical characteristics from those in Western cohorts. Recent studies from Asia have reported lower rates of fibrostenotic complications, greater responsiveness to proton pump inhibitors and potassium-competitive acid blockers, and a high prevalence of asymptomatic esophageal eosinophilia detected during routine screening endoscopy. Longitudinal studies have suggested that many Asian patients exhibit relatively mild inflammatory disease with limited progression, whereas severe fibrostenotic complications appear uncommon. Despite these phenotypic differences, molecular studies have indicated that the fundamental biology of EoE is largely conserved across geographic regions. These findings suggest that Asian and Western EoE likely represent the same underlying immune-mediated disease, with observed clinical differences potentially reflecting variation in disease stage at diagnosis, timing of diagnosis, healthcare systems, environmental exposures, and screening practices. Emerging data from Asia may also challenge the assumption that all patients with EoE inevitably require universal lifelong maintenance therapy. Current maintenance paradigms have largely been established from Western cohorts enriched for fibrostenotic disease and symptom-driven diagnosis, which may not fully represent the broader spectrum of EoE increasingly recognized in Asia. In this review, we summarize current evidence regarding geographic variation in EoE and discuss the potential implications of Asian disease phenotypes for individualized long-term management strategies.
Related
- Advances in Diagnostic Testing for Eosinophilic Esophagitis: Current Approaches, Limitations, and Emerging Technologies
- Lessons Learned: Digital Epidemiology of Eosinophilic Esophagitis and What Google Trends Reveals
- Two pediatric type II achalasia cases complicated by candidal and eosinophilic esophagitis: Successful peroral endoscopic myotomy treatment
- Herpes Simplex Esophagitis Superimposed on Eosinophilic Esophagitis in an Immunocompetent Patient.
- Eosinophilic Esophagitis and Marked Leukocytosis in Alpha-Gal Syndrome: Infection, Allergy, or Hematologic Malignancy?
BibTeX
@article{jung2026eosinophilic,
title = {{Eosinophilic Esophagitis in Asia: Distinct Clinical Phenotypes and Implications for Long-Term Management}},
author = {Kee Wook Jung and Evan S. Dellon},
journal = {Journal of Neurogastroenterology and Motility},
year = {2026},
month = oct,
doi = {10.5056/jnm26126},
url = {https://doi.org/10.5056/jnm26126},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Eosinophilic Esophagitis in Asia: Distinct Clinical Phenotypes and Implications for Long-Term Management
AU - Kee Wook Jung
AU - Evan S. Dellon
PY - 2026
DA - 2026/10/31
JO - Journal of Neurogastroenterology and Motility
DO - 10.5056/jnm26126
UR - https://doi.org/10.5056/jnm26126
AB - Eosinophilic esophagitis (EoE) has traditionally been regarded as a chronic, progressive inflammatory disorder associated with dysphagia, food impaction, and fibrostenotic remodeling. However, growing evidence from Asia suggests that EoE in Asian populations may exhibit distinct epidemiologic and clinical characteristics from those in Western cohorts. Recent studies from Asia have reported lower rates of fibrostenotic complications, greater responsiveness to proton pump inhibitors and potassium-competitive acid blockers, and a high prevalence of asymptomatic esophageal eosinophilia detected during routine screening endoscopy. Longitudinal studies have suggested that many Asian patients exhibit relatively mild inflammatory disease with limited progression, whereas severe fibrostenotic complications appear uncommon. Despite these phenotypic differences, molecular studies have indicated that the fundamental biology of EoE is largely conserved across geographic regions. These findings suggest that Asian and Western EoE likely represent the same underlying immune-mediated disease, with observed clinical differences potentially reflecting variation in disease stage at diagnosis, timing of diagnosis, healthcare systems, environmental exposures, and screening practices. Emerging data from Asia may also challenge the assumption that all patients with EoE inevitably require universal lifelong maintenance therapy. Current maintenance paradigms have largely been established from Western cohorts enriched for fibrostenotic disease and symptom-driven diagnosis, which may not fully represent the broader spectrum of EoE increasingly recognized in Asia. In this review, we summarize current evidence regarding geographic variation in EoE and discuss the potential implications of Asian disease phenotypes for individualized long-term management strategies.
SN - 2093-0879
SN - 2093-0887
ER -