Eosinophilic esophagitis (EoE) is an allergic disease characterized by eosinophilic inflammation, tissue remodeling (e.g. fibrosis), and dysfunction of the esophagus. Symptoms include trouble swallowing (dysphagia), food getting stuck in the esophagus (impaction), regurgitation, abdominal pain, and GI distress/vomiting. Clinical limitations include: 1) Diagnosis and monitoring of EoE requires multiple invasive upper endoscopic procedures to retrieve esophageal biopsies for histopathological assessment of eosinophilic infiltrate. 2) The manual quantification of tissue eosinophils is a laborious and subjective process. 3) The disease mechanisms of EoE are not well understood and treatment options are limited. Mouse models that recapitulate pathology seen in human EoE have been critical in advancing our understanding of EoE to help address these limitations. Recently, there have been efforts to develop pig models of EoE, as pig esophageal anatomy better resembles that of humans. We designed and optimized an immunohistochemistry (IHC) staining protocol targeting eosinophil peroxidase (EPX), an eosinophil-specific granule protein, to assess esophageal eosinophilia in a pig model of EoE. The optimized IHC protocol demonstrated successful positive staining of eosinophils in pig esophageal tissue samples and distinguished a pig model of EoE from controls. EPX staining is a useful tool for evaluating pig eosinophils by IHC. This novel IHC staining protocol provides the opportunity to further our current understanding of the histopathology, immunologic mechanisms, and potential treatment options for EoE.

Eosinophilic Esophagitis, EoE, is a newer autoimmune chronic esophageal inflammatory illness that results from food allergen triggers (Lucendo, 2017). EoE has created a wide range of diagnostic challenges for physicians because of the similarities that it has compared to gastroesophageal reflux disease, GERD. Current research indicates that EoE predominately impacts males at higher rates compared to females, while White males are most affected by and at risk for developing EoE compared to people of other racial and ethnic backgrounds (Sperry, 2012). Despite these findings, there continues to be an absence of research on social factors and identities like gender, race, ethnicity, income, sexuality and more, that are neglected in understanding how these features interact with EoE. Thus, the purpose of this thesis was to provide more evidence on identity and social aspects in relation to EoE that remain ignored and explain why there might be difficulties in investigating these topics. Moreover, a survey was also developed in order to better understand the current EoE population between the ages of 18 to 26, in which the transition from pediatric to adult care occurs. Language has been shown to affect patient’s care and treatment regarding their health because of discriminations that patients have been subjected to in the past. Therefore, it is important to discuss the role played by language and political correctness, especially within surveys. This thesis will explore the depth of study that has been completed within neglected areas of research surrounding marginalized communities, while providing new insights and questions for future possible research regarding EoE. This will be accomplished by discussing the existing problems within each topic and draw conclusions as to why EoE research may have been hindered within these neglected subjects. This project will provide a literature review, survey development, and language strategies for conducting inclusive and diverse populations and research topics centered around EoE.