EoE ToT Module 2 References-Pathophysiology and Current Treatment for EoE

Video Transcription

Video Summary

The presentation focuses on eosinophilic esophagitis (EOE), exploring its pathophysiology and treatment. The lecturer begins with a clinical case of a 20-year-old man with severe EOE since childhood, highlighting the disease's impact. His condition worsened over time due to noncompliance, leading to inflammation and narrowing of the esophagus, eventually requiring dilation.<br /><br />The pathophysiology section delves into the immunological underpinnings of EOE. It explains how food allergens trigger eosinophils in the epithelium, setting off inflammatory Th2 cells. This cascade releases cytokines like IL-4, IL-13, and IL-5, leading to eosinophils and mast cells infiltrating tissue and causing fibrosis, remodeling, and esophageal dysfunction.<br /><br />Treatment goals for EOE include symptom improvement, histopathological success, and esophageal healing. The talk identifies various therapies like PPIs, topical corticosteroids, diet modifications, and new biologics, stressing the importance of shared decision-making between physician and patient. There’s an emphasis on the need for maintenance therapy to prevent disease progression and complications.<br /><br />Novel treatments like budesonide and fluticasone orally dissolvable tablets show promise. Additionally, the emergence of biologics like dupilumab and syndacomab offers hope for addressing the systemic allergic aspects of EOE. Non-invasive monitoring tools like the string test, Cytosponge, and transnasal endoscopy could revolutionize diagnostics and patient follow-ups, reducing the need for invasive procedures.<br /><br />Shared decision-making is underscored as critical, involving a collaborative approach to therapy choice. Emphasizing patient education about the disease and treatment mechanisms ensures optimal management of this chronic condition.

Asset Subtitle

Nirmala Gonsalves, MD

Keywords

eosinophilic esophagitis

pathophysiology

treatment

food allergens

cytokines

PPIs

topical corticosteroids

biologics

shared decision-making

non-invasive monitoring