ASGE Recognized Industry Associate (ARIA) Training Program for Regeneron and Sanofi | June 2023-Pathophysiology and Current Treatment for EoE

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Eosinophilic esophagitis (EoE) is a chronic condition characterized by inflammation in the esophagus. The pathophysiology of EoE involves several key inflammatory mediators, including thymic stromal lymphopoietin (TSLP), interleukin-4 (IL-4), IL-5, IL-13, eotaxin-3, and mast cells. These mediators contribute to eosinophil infiltration, tissue remodeling, and disruption of the esophageal barrier. The primary goals of therapy in EoE are to improve symptoms, control inflammation, and prevent complications such as strictures and food impactions.<br /><br />Currently, there are several treatment options available for EoE, including dietary modifications, proton pump inhibitors (PPIs), topical steroids, esophageal dilation, and biologic therapies. Dietary treatment options include elemental diets, six-food elimination diets (SFED), and allergy-directed elimination diets. PPIs have also shown efficacy in reducing inflammation in some patients with EoE. Topical steroids, such as budesonide, are commonly used as a first-line therapy to reduce esophageal inflammation. Esophageal dilation may be necessary in patients with strictures or narrowing of the esophagus. Biologic therapies, including dupilumab and monoclonal antibodies targeting IL-5, IL-13, and IL-4 receptors, are being investigated for the treatment of EoE.<br /><br />Assessing response to therapy in EoE involves various measures, including histopathology (eosinophil counts), symptom resolution, and endoscopic improvement. Chronic therapy is recommended for EoE due to the persistent nature of the disease and the rapid recurrence of symptoms after treatment cessation. Novel steroid delivery systems, such as orally disintegrating tablets and biologics, show promise as treatment options for EoE. These therapies target specific inflammatory pathways and aim to improve symptom control and reduce esophageal inflammation. In refractory cases, a multidisciplinary approach is often necessary to optimize therapy and target specific patient needs.<br /><br />Overall, the management of EoE requires individualized treatment plans based on patient preferences, disease severity, and response to therapy. Ongoing research is needed to further understand the pathophysiology of EoE and develop effective treatment strategies.

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Nirmala Gonsalves, MD

Keywords

Eosinophilic esophagitis

inflammation

pathophysiology

therapy

symptoms

complications

treatment options

eosinophil infiltration

esophageal barrier

chronic condition