ASGE Esophagology: Tailoring Management from Testing to Treatment (Live and Virtual) | July 2022-Hirano

Hirano_Update on esosinophilic Esophagitis

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Summary:<br /><br />Dr. Ikuo Hirano from Northwestern University Feinberg School of Medicine presented an update on Eosinophilic Esophagitis (EoE) at the OHSU Best of DDW 2016 conference. Hirano discussed several key points regarding EoE management. Firstly, symptoms are a reliable indicator of disease activity, and it's important to assess endoscopic features and histopathology. Secondly, maintenance therapy is unnecessary for most patients. Thirdly, endoscopy can accurately detect esophageal strictures, contrary to the misconception that it has limited sensitivity in this regard. Lastly, treatment refractory disease is uncommon. However, there are several challenges to symptom assessment in EoE, including the multifactorial nature of the condition and the importance of considering cognitive factors such as anxiety and hypervigilance. The presentation also highlighted the importance of treating to target in EoE, with optimal management including objective measures of disease activity such as resolution of dysphagia, histopathology, and endoscopy findings. The natural history of EoE was also discussed, with evidence suggesting that longer duration of untreated disease can lead to stricture formation. The presentation emphasized the use of swallowed topical corticosteroid therapy as a maintenance therapy for EoE based on strong recommendations. This was supported by the 2020 AGA-JTF guidelines. Additionally, emerging therapies such as budesonide orodispersible tablets and cendakimab (RPC4046) were mentioned. In conclusion, this update on EoE management aimed to address common misconceptions and provide insights into the current state and future directions of EoE treatment.

Keywords

Eosinophilic Esophagitis

EoE

symptoms

endoscopic features

histopathology

maintenance therapy

esophageal strictures

treatment refractory disease

swallowed topical corticosteroid therapy

emerging therapies