EoE ToT Module 5 References-Dellon ES et al Gastroenterology 2014 Advances in clinical management of eosinophilic esophagitis

Dellon ES et al Gastroenterology 2014 Advances in clinical management of eosinophilic esophagitis

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"Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated condition increasingly recognized as a significant cause of upper gastrointestinal issues in both children and adults. Diagnosed by symptoms of esophageal dysfunction and confirmed with at least 15 eosinophils per high-power field in biopsy specimens, the disease requires exclusion of other causes such as proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE).<br /><br />Clinically, EoE presents differently in children and adults. Children often have symptoms like vomiting, abdominal pain, and feeding difficulties, whereas adults frequently experience solid food dysphagia. EoE is associated with high rates of atopy, including asthma and allergic rhinitis, and often coexists with other inflammatory disorders. Endoscopic examination usually reveals features such as esophageal rings, furrows, and white plaques, although these can vary between children and adults. Histologically, the presence of eosinophilic infiltration, degranulation, and basal cell hyperplasia are key indicators.<br /><br />Current treatment strategies for EoE include pharmacologic options, dietary modifications, and endoscopic dilation for strictures. Topical corticosteroids like fluticasone and budesonide are the mainstays for pharmacologic therapy, showing efficacy in reducing eosinophil counts and alleviating symptoms. Systemic corticosteroids are reserved for severe cases due to their potential long-term adverse effects. <br /><br />Dietary interventions involve the elimination of allergenic foods identified either empirically or via allergy testing, with elemental diets being particularly effective. A key challenge with dietary therapy includes patient compliance, especially with elemental diets, which are expensive and often not covered by insurance.<br /><br />Endoscopic dilation helps manage esophageal strictures and narrow-caliber esophagus but does not address underlying inflammation. <br /><br />Ongoing research is exploring less invasive diagnostic methods and potential biomarkers for EoE, with the aim of improving diagnostic accuracy and treatment outcomes. The treatment approach should be individualized, and the management of EoE benefits from a multidisciplinary approach involving gastroenterologists, allergists, pathologists, and dietitians."

Keywords

Eosinophilic esophagitis

EoE

esophageal dysfunction

eosinophils

PPI-REE

dietary modifications

topical corticosteroids

elemental diets

endoscopic dilation

multidisciplinary approach