EoE Module 1 References-Hirano et al Gastroenterology 2020 Approaches and challenges to management of pediatric and adult patients with EoE

Hirano et al Gastroenterology 2020 Approaches and challenges to management of pediatric and adult patients with EoE

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The document discusses the evolution and current approaches to managing eosinophilic esophagitis (EoE) in both children and adults. Initial treatments like esophageal dilation for adults and elemental formulas for children have evolved into more sophisticated methods including selective food exclusion and the use of swallowed topical corticosteroids. Current management strategies are guided by multidisciplinary recommendations, including those from the American Gastroenterological Association, though effective treatments necessitate clearly defined response criteria.<br /><br />The treat-to-target strategy is recommended, focusing on symptoms, endoscopic findings, and histological results. Notably, response to treatment can vary significantly; for example, symptoms may persist even if histological features improve, or vice versa.<br /><br />EoE treatments now include biologic agents that target specific immune pathways, and empirical elimination diets have gained traction for their effectiveness and reduced need for repeated endoscopies. The document emphasizes that treatment goals are to alleviate symptoms, reduce mucosal inflammation, and prevent complications like esophageal remodeling.<br /><br />Challenges in treatment include assessing symptom severity, requiring validated patient-reported outcomes, and employing endoscopic biopsies to monitor mucosal condition. Treatment approaches must be adaptive to patient age and symptoms, particularly tricky in children due to their changing eating behaviors and potential for multiple endoscopies.<br /><br />Proton pump inhibitors (PPIs), topical corticosteroids, and elimination diets are primary treatments, each with its benefits and drawbacks. PPIs are effective for some patients, whereas topical corticosteroids show heterogeneity in response rates. Elimination diets can be labor-intensive due to the need for endoscopic follow-ups but can be effective with fewer eliminations depending on the patient’s response.<br /><br />The document mentions ongoing developments in biologic treatments targeting specific cytokines involved in EoE and the need for long-term management strategies, including the balance of cost and quality of life. Additionally, it recognizes that an interdisciplinary and personalized approach, bolstered by advancing research, is critical for future advancements in treating this complex and multifaceted disease.

Keywords

eosinophilic esophagitis

EoE management

treat-to-target strategy

topical corticosteroids

biologic agents

elimination diets

proton pump inhibitors

multidisciplinary recommendations

esophageal remodeling

patient-reported outcomes