Eosinophilic esophagitis (EoE) is a chronic antigen-mediated inflammatory disease of the
esophagus that affects both children and adults. The incidence and prevalence of EoE is
rapidly increasing in Western countries with an estimated incidence of 6.6 per 100,000
person-years (95% CI, 3-11.7) in children and 7.7 per 100,000 person-years (95% CI,
1.8-17.8) in adults. Clinically, it is characterized by various symptoms related to
esophageal dysfunction, including vomiting, regurgitation, feeding difficulties,
epigastric heartburn, dysphagia, or food bolus impaction, and may cause growth
retardation. Diagnosis is made on the basis of clinical symptoms and histological
evidence of eosinophilic infiltration of the esophagus (at least 15 eosinophils/high
power microscope field (eos /hpf), excluding other etiologies of esophageal eosinophilia
(gastroesophageal reflux disease, infectious esophagitis, achalasia, celiac disease and
Crohn's disease, connective tissue disorders, gra ft versus host disease, drug
hypersensitivity and hypereosinophilic syndromes). EoE is primarily characterized by a T
helper 2 type inflammation, but the pathogenesis and the immunopathological mechanisms
underlying the pathology are not yet fully understood. Recent evidence suggests that in
genetically predisposed individuals, interaction with environmental factors (e.g.,
dietary lifestyle) may play a role in activating several inflammatory pathways and cause
EoE.
Ultra-processed foods (UPFs) are food and beverage products resulting from industrial
formulations, ready for consumption, typically obtained with five or more ingredients
from different manufacturing processes (cooking methods, addition of additives such as
stabilizers or preservatives). During the last decade, the consumption of the latter has
increased significantly among the pediatric population to represent 30% of the daily
caloric intake of an average child in Europe and America. Recent evidences show that UPFs
favor the onset of chronic non-communicable diseases through the activation of different
inflammatory pathways.
The components mostly represented in UPFs are the advanced glycation end products (AGEs),
a heterogeneous group of highly oxidizing compounds that are formed through non-enzymatic
reactions (Maillard reaction) between reduced sugars and free amino groups of proteins,
lipids, or nucleic acids.
Evidence demonstrates that dietary AGEs are absorbed and contribute significantly to the
total concentration of AGEs in the body. AGEs induce oxidative stress and inflammation,
leading to structural and functional protein alterations, cellular apoptosis and
multi-tissue/organ damage. These mechanisms are mediated at least in part by interactions
with their cell-surface receptor for advanced glycation end-products (RAGE).
The AGEs-RAGE interaction modulates the immune response. AGEs are able to activate le
mast cells, to stimulate the release of histamine and to induce a chronic inflammatory
state that promotes a T helper 2 type response.