EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (Virtual Only) | January 2023-Hirano_Eosinophilic Esophagitis Diet and Medical Therapy

Hirano_Eosinophilic Esophagitis Diet and Medical Therapy

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This document provides an update on the management of eosinophilic esophagitis (EoE), a chronic immune-mediated disease characterized by inflammation of the esophagus. The document discusses commonly used therapies and the role of novel biologics in treating EoE.<br /><br />Commonly used therapies for EoE include drugs such as proton pump inhibitors (PPIs) and swallowed topical corticosteroids. PPIs are no longer required for the diagnosis of EoE but are recommended as a first-line treatment option due to their effectiveness, availability, ease of administration, and safety. Swallowed topical corticosteroids have been shown to benefit both children and adults with EoE, with a strong recommendation in the 2020 AGA-JTF guideline. However, they can have potential side effects such as oral and esophageal candidiasis and long-term systemic adverse effects.<br /><br />Diet therapy is another approach to managing EoE. The document discusses different diet therapy options, including elemental diet, empiric elimination diet, and allergy-testing directed diet. The AGA-JTF suggests using elemental diet or an empiric, 6-food elimination diet over no treatment. However, the quality of evidence for allergy-testing directed diet is low.<br /><br />The document also mentions the development of novel biologics for EoE. Dupilumab, an IL-4 receptor α monoclonal antibody, has shown promise in reducing dysphagia and esophageal eosinophilia, and it has been approved by the FDA for the treatment of EoE in children and adults. Other biologics and oral immunomodulators are currently in development for EoE and other eosinophilic gastrointestinal disorders.<br /><br />Overall, shared decision making is important in selecting the initial therapy for EoE, taking into account the effectiveness, administration, safety, and cost of different treatment options. The document also emphasizes the importance of involving a dietician and allergist in the management of EoE and the need for regular monitoring and follow-up with endoscopies.

Keywords

eosinophilic esophagitis

EoE

chronic immune-mediated disease

inflammation

therapies

proton pump inhibitors

swallowed topical corticosteroids

diet therapy

biologics

dupilumab