Module 9 References-Chehade et al J Allergy Clin Immunol 2023 Breakthroughs in understanding and treating eosinophilic GI diseases

Chehade et al J Allergy Clin Immunol 2023 Breakthroughs in understanding and treating eosinophilic GI diseases

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The 2022 CEGIR/TIGERs Symposium at the American Academy of Allergy, Asthma & Immunology meeting presented groundbreaking insights into eosinophilic gastrointestinal diseases (EGIDs). These conditions, notably eosinophilic esophagitis (EoE) and eosinophilic gastritis (EoG), were discussed in terms of their epidemiology, genetics, pathology, diagnostics, and treatment advancements.<br /><br />### Epidemiology and Genetics:<br />Current data suggest an increasing incidence of EoE, estimated at 5-10 cases per 100,000. Genetic epidemiology has identified over 21 risk loci for EoE, highlighting the significant genetic component of the disease. Research emphasizes the need for diverse genetic studies to enhance the understanding of various ancestral backgrounds.<br /><br />### Pathology and Diagnoses:<br />Key diagnostic tools, including the Eosinophilic Gastritis Reference Score (EG-REFS) and the EoE Histology Scoring System (EoEHSS), have shown effectiveness in correlating endoscopic and histologic findings with disease activity. These tools help characterize the patchy and nonuniform nature of EGID-specific tissue changes, leading to more accurate diagnoses.<br /><br />### Monitoring and Treatment Effectiveness:<br />Monitoring EoE through clinical symptoms alone is insufficient given variability among patients and modest predictive capacity. Histology-based end points are essential for both clinical trials and real-world practice, although clear criteria for histologic response remain debated.<br /><br />### Immunotherapy:<br />Oral immunotherapy (OIT) causes transient esophageal eosinophilia in a substantial number of subjects, complicating its use. The potential role of aeroallergens as EoE triggers is debated, with mixed evidence on whether subcutaneous immunotherapy (SCIT) is beneficial.<br /><br />### Pathogenesis:<br />Research continues to unravel the roles of eosinophils, mast cells, and T cells. Eosinophils significantly contribute to epithelial damage, yet mast cells are increasingly recognized for their role in remodeling and ongoing inflammation. <br /><br />### Multidisciplinary Management:<br />A multidisciplinary approach involving gastroenterologists, allergists, dietitians, and other specialists is critical. This is particularly relevant for effective treatment strategies, including the use of proton pump inhibitors, topical corticosteroids, and dietary management for EoE.<br /><br />### Novel Therapies:<br />Emerging treatments, including biologics like dupilumab, which targets type 2 cytokines, offer promising advancements. However, more data on safety, efficacy, and individualized treatment plans are needed.<br /><br />### Summary:<br />The symposium underscored the complexity of EGIDs and the need for a collaborative approach in research and clinical practice to continue advancing the understanding and management of these chronic conditions. Future efforts should focus on more precise genetic and phenotypic characterization and investigations into long-term treatment efficacy and safety.

Keywords

CEGIR/TIGERs Symposium

eosinophilic gastrointestinal diseases

EoE

EoG

genetic epidemiology

diagnostic tools

immunotherapy

multidisciplinary management

novel therapies

biologics