EoE ToT Module 3 References-Hirano et al Gastroenterology 2020 Approaches and challenges to management of pediatric and adult patients with EoE

Hirano et al Gastroenterology 2020 Approaches and challenges to management of pediatric and adult patients with EoE

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The document discusses various approaches and challenges related to managing eosinophilic esophagitis (EoE) in pediatric and adult patients. EoE is an inflammatory condition of the esophagus characterized by high levels of eosinophils. Initially, treatment for children involved elemental formula, while adults underwent esophageal dilation. Contemporary management has evolved to include the selective exclusion of food triggers and the use of swallowed topical corticosteroids. <br /><br />Guidelines from the American Gastroenterological Association (AGA) and other bodies outline these approaches, though effective treatments are crucially gauged using a "treat-to-target" methodology based on symptomatic, endoscopic, and histological improvements. This complexity arises because patients often show divergent responses; for example, some might have symptom resolution post-esophageal dilation despite ongoing histologic inflammation.<br /><br />New treatments, including biologics that target specific immune pathways, are under development, along with empiric elimination diets that reduce the need for repeated endoscopies. Unique pediatric considerations include the impact of anesthesia and the social and developmental challenges associated with strict dietary regimens.<br /><br />Significant therapeutic goals for EoE involve minimizing symptoms, reducing mucosal inflammation, and preventing esophageal remodeling complications like strictures. Noteworthy challenges in evaluating treatment efficacy include the dissociation between symptoms and histologic or endoscopic findings, varying children’s eating behaviors, and repeated biopsy requirements.<br /><br />Pharmacologic and dietary treatments are foundational, but there is a growing interest in novel therapies targeting IL-5, IL-13, and other cytokines implicated in EoE’s pathogenesis. Both proton pump inhibitors (PPIs) and swallowed corticosteroids play key roles, and emerging approaches for less invasive disease monitoring and more personalized medicine are anticipated to significantly impact future care.<br /><br />Finally, long-term management involves balancing cost, quality of life, and sustained control of disease activity, acknowledging that many patients may require continuous therapy to mitigate the progression of esophageal damage. The document underscores the importance of personalized treatment plans and ongoing research to refine EoE management strategies.

Keywords

eosinophilic esophagitis

pediatric EoE

adult EoE

elemental formula

esophageal dilation

topical corticosteroids

AGA guidelines

biologics

empiric elimination diets

cytokines