Despite dramatic advances in our understanding of the pathogenesis and course of disease in the relatively short timeframe since the discovery and first description of eosinophilic esophagitis (EoE) less than three decades ago, many open questions remain to be elucidated. For instance, we will need to better characterize atypical clinical presentations of EoE and other forms of esophageal inflammatory conditions with often similar clinical presentations, nut fulfilling current diagnostic criteria for EoE and to determine their significance and interrelationship with genuine EoE. In addition, the interrelationship of EoE with other immune-mediated diseases remains to be clarified. Hopefully, a closer look at the role of environmental factors and their interaction with genetic susceptibility often in context of atopic predisposition may enable identifying the candidate substances/agents/allergens and potentially earlier (childhood) events to trigger the condition. It appears plausible to assume that in the end—comparable to current concepts in other immune-mediated chronic diseases, such as for instance inflammatory bowel disease or asthma bronchiale—we will not be rewarded with the identification of a “one-and-only” underlying pathogenetic trigger factor, with causal responsibility for the disease in each and every EoE patient. Rather, the relative contribution and importance of intrinsic susceptibility, i.e., patient-driven factors (genetics, aberrant immune response) and external trigger factors, such as food (or aero-) allergens as well as early childhood events (e.g., infection and exposure to antibiotics and other drugs) may substantially differ among given individuals with EoE. Accordingly, selection and treatment duration of medical therapy, success rates and extent of required restriction in dietary treatment, and the need for mechanical treatment to address strictures and stenosis require an individualized approach, tailored to each patient. With the advances of emerging treatment options, the importance of such an individualized and patient-centered assessment will increase even further.

尽管自不到三十年前发现和首次描述嗜酸性粒细胞性食管炎 (EoE) 以来，我们在相对较短的时间内对发病机制和病程的理解取得了巨大进展，但仍有许多悬而未决的问题有待阐明。例如，我们需要更好地表征 EoE 的非典型临床表现和其他形式的食管炎症，通常具有相似的临床表现，满足 EoE 的当前诊断标准，并确定它们的重要性和与真正 EoE 的相互关系。此外，EoE 与其他免疫介导疾病的相互关系仍有待阐明。希望，仔细研究环境因素的作用及其与遗传易感性的相互作用，通常是在特应性易感性的背景下，可能有助于识别候选物质/试剂/过敏原和潜在的早期（童年）事件触发条件。与其他免疫介导的慢性疾病（例如炎症性肠病或支气管哮喘）中的当前概念相比，我们最终将不会因识别出“唯一”而获得奖励，这似乎是合理的。潜在的致病触发因素，对每个 EoE 患者的疾病负有因果关系。相反，内在易感性的相对贡献和重要性，即患者驱动因素（遗传学、异常免疫反应）和外部触发因素，例如食物（或空气）过敏原以及儿童早期事件（例如感染和接触抗生素和其他药物）可能在特定的 EoE 个体之间存在很大差异。因此，药物治疗的选择和治疗持续时间、成功率和饮食治疗所需限制的程度，以及解决狭窄和狭窄的机械治疗的需要，都需要针对每个患者量身定制的个性化方法。随着新兴治疗方案的进步，这种个性化和以患者为中心的评估的重要性将进一步增加。饮食治疗中所需限制的成功率和程度，以及解决狭窄和狭窄的机械治疗的需要，需要针对每个患者量身定制的个性化方法。随着新兴治疗方案的进步，这种个性化和以患者为中心的评估的重要性将进一步增加。饮食治疗中所需限制的成功率和程度，以及解决狭窄和狭窄的机械治疗的需要，需要针对每个患者量身定制的个性化方法。随着新兴治疗方案的进步，这种个性化和以患者为中心的评估的重要性将进一步增加。