EoE Module 14 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 condition characterized by inflammation of the esophagus. Affecting approximately 150,000 individuals in the U.S., it presents primarily with symptoms like dysphagia, food impaction, and esophageal strictures. Diagnosis is based on esophageal dysfunction and the presence of at least 15 eosinophils per high-powered field in esophageal biopsy, once other conditions are ruled out. Genetic and environmental factors, such as antibiotic exposure in infancy, might increase susceptibility.<br /><br />The pathology of EoE involves a mixed granulocyte infiltration into the esophageal mucosa, leading to fibrosis over time. Commonly affected foods include milk and wheat, underscoring the role of dietary influences. First-degree relatives of EoE patients are at higher risk, highlighting genetic predispositions.<br /><br />Diagnosis relies heavily on endoscopy and biopsy. Current treatments include proton pump inhibitors (PPIs), topical steroids such as fluticasone and budesonide, dietary therapy through food elimination or elemental diets, and endoscopic dilation for esophageal narrowing.<br /><br />Among treatment options, PPIs show a 41.7% histologic response rate, and topical corticosteroids demonstrate a 64.9% remission rate in trials. Endoscopic dilation is reserved for symptomatic esophageal narrowing but doesn't address underlying inflammation. Long-term maintenance therapy with topical steroids is often recommended to prevent complications like esophageal fibrosis or narrowing, which are associated with untreated EoE.<br /><br />Dietary modification, involving varying degrees of food elimination, can also be effective but require endoscopy to identify specific triggers. Emerging therapies, including biologics, are undergoing trials but are currently recommended only within those contexts.<br /><br />In summary, EoE requires a nuanced approach to diagnosis and treatment, with a focus on symptom control, minimizing esophageal damage, and using a patient-centered approach in therapy choice. Regular monitoring through endoscopy is crucial for assessing treatment efficacy and disease progression.

Keywords

Eosinophilic Esophagitis

chronic inflammation

dysphagia

esophageal biopsy

genetic predisposition

dietary therapy

proton pump inhibitors

topical steroids

endoscopic dilation

biologics