ASGE Esophagology General GI Practice Virtual Program (LIVE Virtual) | April 2021-Update on Management of Esosinophilic Esophagitis

Pdf Summary

Dr. David A. Katzka, of Mayo Clinic, provided an update on the management of eosinophilic esophagitis (EoE) at the ASGE 2021 conference. He emphasized the importance of using multiple parameters to assess treatment response, including eosinophil counts, symptom scores, endoscopic abnormalities, and imaging. Various scoring systems, such as the Mayo Dysphagia Questionnaire and EoE activity index, can be used to evaluate symptoms.<br /><br />The severity of EoE can be categorized into mild or severe based on the percentage of esophageal surface area affected by white lesions. The presence of exudates, also known as white exudates, plaques, or punctate white spots, can also be used as a reference score for endoscopic abnormalities.<br /><br />Dr. Katzka discussed the use of therapies in EoE, such as steroids like fluticasone and budesonide. He also mentioned the SFED diet therapy, which has shown promising results in managing EoE.<br /><br />New monitoring techniques for EoE were highlighted, including the use of a functioning luminal imaging probe (FLIP) and the development of biologics for treatment. Dupilumab and RPC4046, monoclonal antibodies targeting IL13, have shown efficacy in reducing histologic and endoscopic activity in EoE patients.<br /><br />However, Dr. Katzka noted some hesitations with biologic therapies, including their cost, immunosuppression effects, and long-term risks. He emphasized that EoE has no premalignant potential and does not directly cause death, although it can significantly impact quality of life.<br /><br />Regarding maintenance therapy, Dr. Katzka suggested considering it for most, if not all, EoE patients. High-risk patients, such as those with a small caliber esophagus or rapid recurrence after stopping therapy, may particularly benefit from maintenance treatment.<br /><br />In summary, Dr. Katzka recommended using multiple parameters to assess EoE treatment response, considering various therapies including steroids and diet therapy, and keeping an eye on the development of biologics for refractory cases. Maintenance therapy should be considered for most EoE patients.

Asset Subtitle

David A. Katzka, MD

Keywords

eosinophilic esophagitis

EoE

treatment response

endoscopic abnormalities

scoring systems

steroids

SFED diet therapy

biologics

maintenance therapy

high-risk patients