EoE Module 10 References-Muir et al JAMA 2021 Eosinophilic esophagitis A review

Muir et al JAMA 2021 Eosinophilic esophagitis A review

Pdf Summary

Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disease of the esophagus affecting around 150,000 people in the United States, both children and adults. The condition manifests through symptoms of esophageal dysfunction such as vomiting, dysphagia, or feeding difficulties, confirmed by an esophageal biopsy showing at least 15 eosinophils per high-powered field, excluding other conditions like gastroesophageal reflux disease.<br /><br />EoE's diagnostic process typically involves endoscopy with biopsy, revealing endoscopic features like furrows, trachealization, edema, and strictures. Histologically, it is marked by eosinophilic infiltration, which leads to basal cell hyperplasia and fibrosis over time.<br /><br />The pathophysiology of EoE is not fully understood but involves genetic and environmental factors, including antibiotic exposure in infancy. Treatments include proton pump inhibitors (PPIs), topical steroids like fluticasone and budesonide, dietary interventions with elemental or empiric food elimination diets, and endoscopic dilation for esophageal narrowing. However, therapy selection is personalized based on patient preference, cost, and efficacy, with shared decision-making being essential.<br /><br />PPIs are often used as a first-line treatment due to their anti-inflammatory properties and ability to induce histologic remission in approximately 41.7% of patients. Topical steroids show higher efficacy, achieving remission in 64.9% of patients but may cause esophageal candida. Elemental diets were effective in 93.6% of cases but are costly and poorly palatable. Six-food elimination diets are also popular, targeting common allergens like milk and wheat, yielding remission in 67.9% of patients.<br /><br />Patients typically adapt their eating behaviors to manage symptoms, leading to diagnostic delays. Maintenance therapy is recommended to prevent recurrence, which is common after treatment cessation. Future treatment possibilities include monoclonal antibodies targeting eosinophils or inflammatory pathways, currently under clinical trials.<br /><br />This review underscores the importance of regular monitoring and a tailored therapeutic approach for managing EoE, highlighting the condition's potential to cause significant esophageal damage if untreated.

Keywords

Eosinophilic esophagitis

esophageal dysfunction

endoscopy

biopsy

proton pump inhibitors

topical steroids

dietary interventions

shared decision-making

esophageal narrowing

monoclonal antibodies