EoE ToT Module 2 References-Muir et al JAMA 2021 Eosinophilic esophagities A review jama_muir_2021_rv_210013

Muir et al JAMA 2021 Eosinophilic esophagities A review jama_muir_2021_rv_210013_1633385112.40093

Pdf Summary

Eosinophilic Esophagitis (EoE) is a chronic immune-mediated inflammatory condition of the esophagus affecting approximately 34.4/100,000 individuals in Europe and North America. It presents with symptoms like dysphagia, food impaction, and esophageal strictures. EoE is diagnosed through esophageal biopsies showing at least 15 eosinophils per high-power field in the absence of other conditions like gastroesophageal reflux disease.<br /><br />The pathophysiology is linked to genetic and environmental factors, such as early antibiotic exposure. Symptoms vary by age, from nonspecific signs in young children to more evident esophageal fibrosis and food impaction in adults. Diagnosis primarily involves endoscopy with biopsies, while new less-invasive methods like the esophageal string test and transnasal endoscopy are under study.<br /><br />Treatment approaches for EoE include:<br />1. **Proton Pump Inhibitors (PPIs)**: Effective in about 41.7% of patients, PPIs reduce histologic and symptomatic manifestations.<br />2. **Topical Steroids**: Swallowed corticosteroids like fluticasone and budesonide show a 64.9% histologic remission rate.<br />3. **Dietary Management**: Elemental diets have a high success rate but pose practical challenges. Empirical food elimination diets (like the 6-food elimination diet) and allergy test-directed diets also reduce eosinophilia significantly.<br />4. **Dilation**: Reserved for patients with esophageal narrowing and strictures, providing symptomatic relief with minimal risks of perforation or bleeding.<br /><br />Given its progressive nature, maintenance therapy is required to avoid esophageal fibrosis, with treatments selected based on shared decision-making that considers efficacy, ease of administration, and patient preference. Emerging therapies like monoclonal antibodies are showing potential in clinical trials.<br /><br />EoE's increasing prevalence could be due to heightened awareness and diagnostic practices. Observational studies suggest that untreated EoE can lead to more severe outcomes, emphasizing the need for effective long-term management strategies.

Keywords

Eosinophilic Esophagitis

EoE

chronic inflammatory condition

dysphagia

esophageal strictures

endoscopy

Proton Pump Inhibitors

Topical Steroids

Dietary Management

maintenance therapy