Cognitive heterogeneity in mild cognitive impairment due to Alzheimer's disease pathology.

Eosinophilic esophagitis (EoE) is a chronic, type 2-associated, inflammatory disease, restricted to the esophagus. It is characterized by abnormal infiltration of the organ by eosinophils (≥ 15 peak eosinophils/high-powered field) and symptoms of esophageal dysfunction, after other causes of esophageal eosinophilia have been excluded [, ]. Described in the 1990 s [, ], EoE was initially considered a rare disease. However, in the last decade its frequency has increased sharply to represent, currently, the leading cause of dysphagia and food impaction in children, adolescents and adults up to their 5th decade of life [, ]. From a pathophysiological point of view, EoE results from an immunologically-mediated reaction of the esophageal mucosa against certain foods, therefore being considered as a particular food allergy that frequently presents in association with other concomitant type-2 diseases []. The diagnosis of EoE in a subject with suspicious symptoms requires an endoscopy with biopsies [, ]. Different treatment alternatives for EoE are available, including proton pump inhibitors (PPI) [], dietary modifications to restrict exposure to potential allergens [], esophageal formulas of swallowed topical corticosteroids (STC) with low bioavailability [, ], and dupilumab, a biological drug [, ]. As the effectiveness of these therapies is limited, and symptom assessment is not accurate to predict esophageal inflammation [], disease remission after any course of treatment should be objectively assessed [], and patients often need to use several options before achieving disease control []. Due to its chronic nature, inflammation recurs after stopping treatment []. Therefore, most patients require maintenance treatment to maintain disease remission long term and to avoid complications []. The lack of reliable non- or minimally invasive methods to evaluate oesophageal inflammation or disease complications means that these patients require endoscopy with biopsies for diagnosis, evaluation of response to any treatment and long-term monitoring [, ]. As a result, EoE is health resource-intensive due to: diagnostic delay, repeat clinic or emergency rooms visits, dependence on endoscopic assessment, complications, and treatments [] as well as impaired quality of life and the impact on mental health [] from eating-associated anxiety []. The cost that EoE represents for health systems is a scarcely investigated area, with most studies limited to the United States (US) [–]. From their results, we know that before diagnosis the symptoms patients were already experiencing led to increased medical visits []. Outpatient visits, visits to the emergency room and hospital admissions [] were more frequent in patients with EoE than in paired controls [, ], and the resulting annual EoE expenditure was threefold that of control patients in the US. Total EoE-associated health care costs were estimated to be $1.32 billion in 2024 []. In the paediatric population, EoE costs were shown to be above those of Crohn’s and celiac disease [].