Managing eosinophilic esophagitis: challenges and solutions.
Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated condition defined by symptoms of esophageal dysfunction and dense eosinophilic infiltration of the esophageal mucosa. Therapies consist of anti-eosinophilic medications and specialized diets aimed to decrease the progression of EoE and alleviate its symptoms, namely, dysphagia and food impaction. Assessing response to therapy remains challenging, as treatment end points are not well defined and currently consist of clinical, histologic, and endoscopic features. Newer validated measures may help standardize treatment end points. Emerging data support the use of maintenance therapy, which may reduce disease progression. Optimal dosages, delivery techniques, and duration of treatment need to be determined. When features of fibrostenosis develop, esophageal dilation is a safe and effective adjunctive strategy for improving symptoms. In EoE cases refractory to conventional treatments, newer therapies targeting inflammatory mediators and cytokines are on the horizon.
Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Nisha A
NA
Shah
Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Dustin M
DM
Albert
Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Noah M
NM
Hall
Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Fouad J
FJ
Moawad
allergy; corticosteroids; dietary treatment; dilation; dysphagia; eosinophilia; eosinophilic esophagitis; esophagitis
Mayo Clin Proc. 2003 Jul;78(7):830-5
12839078
Am J Gastroenterol. 2007 Oct;102(10):2300-13
17617209
Clin Transl Gastroenterol. 2015 Dec 17;6:e132
26680264
Am J Gastroenterol. 2016 Feb;111(2):206-13
26753894
Clin Gastroenterol Hepatol. 2008 Feb;6(2):165-73
18237866
Dig Dis Sci. 2012 May;57(5):1413-9
22134787
Aliment Pharmacol Ther. 2012 Jan;35(2):300-7
22111863
Gastrointest Endosc. 2010 Apr;71(4):706-12
20170913
PLoS One. 2012;7(11):e50037
23185525
Am J Gastroenterol. 2015 Sep;110(9):1289-97
26303134
Gastroenterology. 2014 Dec;147(6):1255-66.e21
25160980
Allergy. 2014 Sep;69(9):1248-54
24894658
Allergy. 2016 Jun;71(6):889-900
26970242
Gastroenterology. 2016 Mar;150(3):581-590.e4
26584601
J Allergy Clin Immunol. 2015 Feb;135(2):500-7
25226850
J Pediatr Gastroenterol Nutr. 2009 Feb;48(2):152-60
19179876
Gastroenterology. 2010 Aug;139(2):418-29
20457157
J Allergy Clin Immunol. 2012 Aug;130(2):461-7.e5
22743304
Am J Gastroenterol. 2007 Oct;102(10):2271-9; quiz 2280
17581266
J Allergy Clin Immunol. 2014 Nov;134(5):1093-9.e1
25174868
Gastroenterology. 2013 Dec;145(6):1230-6.e1-2
23954315
Aliment Pharmacol Ther. 2013 Sep;38(6):634-42
23837796
J Allergy Clin Immunol Pract. 2013 Jul-Aug;1(4):332-40; quiz 341-2
24565538
Dis Esophagus. 2016 Feb 9;:null
26857345
J Pediatr Gastroenterol Nutr. 2015 Aug;61(2):190-3
25950088
Am J Gastroenterol. 2010 May;105(5):1062-70
19935783
Aliment Pharmacol Ther. 2015 Jul;42(2):231-8
26011446
J Pediatr Endocrinol Metab. 2015 Sep;28(9-10):1101-6
26024243
Gastroenterology. 2010 Nov;139(5):1526-37, 1537.e1
20682320
Endoscopy. 2007 Apr;39(4):376; author reply 377
17427083
Gastroenterology. 2014 Jun;146(7):1639-48
24534634
Gastrointest Endosc. 2011 Jan;73(1):15-21
21067739
Gut. 2016 Mar;65(3):390-9
25792708
Dis Esophagus. 2007;20(3):202-5
17509115
Clin Gastroenterol Hepatol. 2015 Jan;13(1):66-76.e3
24907502
Dig Dis Sci. 2010 May;55(5):1313-9
19533356
N Engl J Med. 2004 Aug 26;351(9):940-1
15329438
Clin Transl Gastroenterol. 2016 Mar 17;7:e155
26986655
Gastroenterology. 2012 Aug;143(2):321-4.e1
22561055
Dig Dis Sci. 2015 Jun;60(6):1572-8
25618310
J Clin Gastroenterol. 2014 Aug;48(7):607-12
24072074
Am J Gastroenterol. 2013 Mar;108(3):366-72
23399553
Clin Gastroenterol Hepatol. 2014 Aug;12(8):1272-9
24440337
Gastroenterology. 2003 Dec;125(6):1660-9
14724818
Am J Gastroenterol. 2013 May;108(5):679-92; quiz 693
23567357
World J Gastroenterol. 2014 Jul 28;20(28):9549-55
25071351
Gastroenterology. 2006 Nov;131(5):1381-91
17101314
Gastrointest Endosc. 2006 Jan;63(1):3-12
16377308
Dig Dis Sci. 2016 Jul;61(7):1996-2001
27093866
J Clin Pathol. 2013 May;66(5):399-402
23393202
Ann Allergy Asthma Immunol. 2005 Oct;95(4):336-43
16279563
Aliment Pharmacol Ther. 2014 Mar;39(6):603-8
24461332
Am J Gastroenterol. 2015 Nov;110(11):1567-75
26416193
J Allergy Clin Immunol. 2007 Jan;119(1):206-12
17208603
Clin Gastroenterol Hepatol. 2015 Mar;13(3):452-8
25086190
Mod Pathol. 2015 Jan;28 Suppl 1:S7-21
25560601
J Allergy Clin Immunol. 2013 Mar;131(3):797-804
23375693
Gastrointest Endosc. 2016 Jun;83(6):1142-8
26608127
J Allergy Clin Immunol. 2012 Feb;129(2):456-63, 463.e1-3
22206777
Gut. 2016 Mar;65(3):524-31
26685124
Clin Gastroenterol Hepatol. 2014 Nov;12(11):1815-23.e2
24657840
Clin Gastroenterol Hepatol. 2012 Jul;10(7):742-749.e1
22475741
J Clin Gastroenterol. 2016 Feb;50(2):134-40
25710524
Am J Gastroenterol. 2013 May;108(5):759-66
23381017
J Allergy Clin Immunol. 2012 Jun;129(6):1570-8
22541246
Gastrointest Endosc. 2014 Apr;79(4):577-85.e4
24275329
Gastroenterology. 2011 Nov;141(5):1593-604
21835135
Am J Gastroenterol. 2013 Dec;108(12):1854-60
24145677
Mod Pathol. 2015 Mar;28(3):383-90
25216228
Aliment Pharmacol Ther. 2013 Oct;38(7):713-20
23915046
Dis Esophagus. 2015 Jan;28(1):42-58
24602224
Gut. 2013 Jun;62(6):824-32
22580413
Aliment Pharmacol Ther. 2011 Apr;33(7):748-57
21320137
Gastroenterol Clin North Am. 2014 Jun;43(2):243-56
24813513
Clin Gastroenterol Hepatol. 2011 May;9(5):400-9.e1
21277394
J Allergy Clin Immunol. 2015 Jan;135(1):187-97
25441638
Gastroenterology. 2012 Jun;142(7):1409-11
22542829
Clin Gastroenterol Hepatol. 2016 Jan;14 (1):13-22.e1
26247167
Expert Rev Clin Immunol. 2014 Jan;10(1):133-42
24236700
Gut. 2013 Apr;62(4):489-95
22619364
Gastrointest Endosc. 2014 Oct;80(4):592-8
24703087
J Pediatr. 2009 Jan;154(1):96-100
18783791
Allergy. 2013 Mar;68(3):375-85
23379537
Clin Gastroenterol Hepatol. 2014 Dec;12(12):2015-22
24993367
Allergy. 2010 Jan;65(1):109-16
19796194
Am J Gastroenterol. 2003 Apr;98(4):777-82
12738455
Clin Gastroenterol Hepatol. 2007 Oct;5(10):1149-53
17683993
Gastroenterology. 2014 Aug;147(2):324-33.e5
24768678
Gastroenterology. 2012 Jun;142(7):1451-9.e1; quiz e14-5
22391333