EoE ToT Module 3 References-Visaggi et al Therap Adv Gastroenterol 2021 EoE Clinical endoscopic histologic therapeutic differences between children and adults

Visaggi et al Therap Adv Gastroenterol 2021 EoE Clinical endoscopic histologic therapeutic differences between children and adults

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Eosinophilic esophagitis (EoE) is a T-helper type 2 (Th2)-mediated chronic esophageal disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. EoE’s pathogenesis involves a complex interaction between genetic and environmental factors, predominantly triggered by food allergens penetrating a defective esophageal mucosal barrier. EoE affects both children and adults, often diagnosed late, with average delays of 4-6 years. This delay can lead to persistent inflammation and the development of fibrotic complications.<br /><br />Key differences in clinical manifestation, diagnostic approaches, and treatment strategies are notable between children and adults. In children, symptoms vary with age, including non-specific gastrointestinal symptoms in infants and dysphagia in older kids. Adults predominantly experience dysphagia and food impaction. EGD with biopsy remains crucial for diagnosis and assessing treatment response, with EoE exhibiting an inflammatory-predominant pattern in children and a fibrotic pattern in adults.<br /><br />Treatment aims to induce and maintain histologic remission, alleviate symptoms, and prevent complications. Treatment interventions include pharmacological options, dietary management, and endoscopic dilation (ED). Proton pump inhibitors (PPIs) and topical corticosteroids are common pharmacologic treatments, effective in reducing inflammation and maintaining remission, though they are primarily used off-label. Dietary management, particularly empiric elimination diets such as the Six-Food Elimination Diet (6-FED) or step-up approaches like the 2-4-6 FED, are effective but often complex and restrictive.<br /><br />Biologic therapies, including monoclonal antibodies targeting immune pathways implicated in EoE, are under investigation. However, none are standard treatments yet. ED is an effective and safe treatment for fibrostenotic complications but has no impact on the underlying inflammation.<br /><br />Identifying EoE early, particularly in children, and tailoring treatment approaches based on age and clinical presentations are crucial for effective management and improving patient outcomes. Despite the progress in understanding and managing EoE, it remains a chronic, relapsing condition requiring vigilant long-term management.

Keywords

Eosinophilic esophagitis

Th2-mediated

esophageal dysfunction

eosinophil inflammation

food allergens

EGD biopsy

histologic remission

proton pump inhibitors

empiric elimination diets

biologic therapies