EoE Module 10 References-Gupta et al CMAJ 2024 Diagnosis and management of EoE

Gupta et al CMAJ 2024 Diagnosis and management of EoE

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Eosinophilic esophagitis (EoE) is a chronic inflammatory condition affecting both children and adults, increasingly diagnosed due to improved recognition and evolving criteria. It’s prevalent in males aged 5–14 and 20–45 years, particularly in colder climates, and is linked to type 2 inflammatory disorders like asthma and atopic dermatitis. EoE arises from a complex interaction between antigen exposures and genetic factors, leading to esophageal inflammation and, potentially, fibrosis or narrowing due to eosinophil infiltration.<br /><br />Clinically, EoE presents primarily as dysphagia, with patients often experiencing food bolus obstruction. Adults may mask symptoms with adaptive behaviors, while children may show non-specific symptoms like abdominal pain or vomiting. Diagnosis involves esophageal biopsies revealing eosinophil presence and differentiation from similar conditions like GERD.<br /><br />Management of EoE includes pharmacological treatments, dietary modifications, and endoscopic dilation if necessary. Proton pump inhibitors (PPIs) are a common first-line treatment, while topical corticosteroids can be used for more severe cases. Dietary changes, such as elimination diets, also play a significant role, but require careful planning. Dupilumab, a biologic, recently gained approval for EoE treatment, showing promise in clinical trials.<br /><br />Current guidelines emphasize shared decision-making to enhance treatment adherence and quality of life. Patients are re-evaluated every 8–12 weeks post-treatment initiation to assess symptoms and esophageal healing. Despite advances, questions about specific inflammation triggers, optimal management strategies, and non-invasive diagnostic technologies remain, indicating areas for future research.

Keywords

Eosinophilic esophagitis

chronic inflammatory condition

dysphagia

type 2 inflammatory disorders

eosinophil infiltration

proton pump inhibitors

topical corticosteroids

elimination diets

dupilumab

shared decision-making