ASGE Recognized Industry Associate (ARIA) Training Program for Sanofi | June 2022-Pathophysiology and Current Treatment for EoE

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The document discusses the pathophysiology and current treatment options for eosinophilic esophagitis (EoE). EoE is a chronic inflammatory condition of the esophagus characterized by the presence of eosinophils. It is associated with atopic disorders and is believed to involve various inflammatory mediators, including thymic stromal lymphopoietin (TSLP), IL-4, IL-5, IL-13, and eotaxin-3.<br /><br />The goals of therapy for EoE are to eliminate symptoms, reduce mucosal inflammation, correct disease consequences, and prevent complications. Treatment options currently available in 2022 include diet management, proton pump inhibitors (PPIs), topical corticosteroids, esophageal dilation, and newer biologic agents. However, there is still no FDA-approved therapy for EoE.<br /><br />Assessing response to therapy involves evaluating symptoms, histopathology, and endoscopy findings. Symptom-based assessment alone is limited due to patient anxieties and food avoidance behaviors. Histopathology assessment involves assessing eosinophil counts, with a target of less than 15 eosinophils per high-power field. Endoscopy evaluation includes checking for inflammatory features and strictures.<br /><br />Chronic therapy is important because the disease persists without treatment, and recurrence of symptoms is common after cessation of therapy. Maintenance therapy with topical corticosteroids is recommended for patients in remission. However, there are issues with long-term use of steroids, including adverse effects and patient concerns.<br /><br />There are also ongoing studies on novel treatment options, including novel steroid delivery systems and biologics. These include drugs that target IL-13, IL-4, eosinophils, and mast cells. However, no FDA approvals have been granted for these therapies as of the document's publication.<br /><br />Refractory EoE can be caused by factors such as inadequate dosing, fibrostenosis, and esophageal hypervigilance. Esophageal hypervigilance is a condition where patients have heightened awareness and anxiety about symptoms related to their esophagus.<br /><br />In summary, EoE is a complex condition that requires a multifaceted approach for management, including diet modification, medication therapy, and careful monitoring of response to treatment. Ongoing research is being conducted to develop more targeted and effective therapies for EoE.

Asset Subtitle

Gary W. Falk, MD, MS, MASGE

Keywords

eosinophilic esophagitis

chronic inflammatory condition

inflammatory mediators

treatment options

topical corticosteroids

biologic agents

symptom-based assessment

endoscopy evaluation

maintenance therapy

ongoing research