EoE Module 10 References-Hirano et al Gastroenterology 2020 Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis

Hirano et al Gastroenterology 2020 Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis

Back to course

Pdf Summary

The management of Eosinophilic Esophagitis (EoE), a chronic immune-mediated esophageal disorder characterized by eosinophil infiltration, has evolved significantly over the past decades. Initially treated with elemental diets for children and esophageal dilation for adults, EoE management now includes targeted dietary eliminations and pharmacologic therapies such as swallowed topical corticosteroids. Effective management requires overcoming notable challenges, including dissociation between symptom resolution and histology findings and the necessity for endoscopies during food reintroduction.<br /><br />Despite no FDA-approved treatments for EoE, investigational pharmacological solutions such as phase 2 and 3 trials of esophageal-optimized corticosteroids and eosinophil-targeted therapies are being conducted. Treatment approaches focus on dietary management by eliminating trigger foods to improve symptoms and reduce esophageal inflammation. Less-restrictive diets have shown promise, potentially reducing the number of required endoscopies.<br /><br />Treatment goals for EoE include the elimination of symptoms, reduction of mucosal inflammation, and prevention of complications like esophageal strictures. Biologic agents targeting immune pathways are promising additions to therapeutic options. Patient management is complicated by variations in symptom presentation and non-responsiveness to treatments, often attributed to the broad anti-inflammatory effect of corticosteroids or variances in dietary and pharmacologic interventions.<br /><br />Validated patient-reported outcome measures are now available to better assess treatment efficacy. The discussion on optimizing EoE treatment notes the potential for combination therapies, albeit with limited data supporting simultaneous diet and medication use.<br /><br />Future directions in EoE management emphasize the need for personalized medicine approaches, integrating medical and dietary therapies, improving non-invasive monitoring tools, and advancing in identifying therapeutic targets and biomarkers. Long-term treatment considerations highlight the importance of addressing patient quality of life and balancing treatment burden with the risk of disease progression.

Keywords

Eosinophilic Esophagitis

immune-mediated disorder

eosinophil infiltration

dietary eliminations

topical corticosteroids

pharmacologic therapies

esophageal inflammation

biologic agents

patient-reported outcomes

personalized medicine