Medical and dietary management of eosinophilic esophagitis

Publication date: Available online 10 May 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Quan M. Nhu, Seema S. Aceves
ObjectiveEosinophilic esophagitis (EoE) is a disease of chronic, allergen-driven, T-helper 2 (Th2) immune-mediated inflammation that progresses to fibrostenosis of the esophagus if left untreated. There are currently no FDA-approved drugs for the treatment of EoE. This review focuses on medical and dietary management of EoE.Data SourcesManuscripts on EoE treatments are identified on PubMed.Study SelectionsOriginal research, randomized control trials, retrospective studies, meta-analyses, case series, and on occasions, case reports of high relevance, are selected and reviewed.ResultsCurrent treatment strategies available to EoE patients center on monotherapy or combination therapy with dietary modification to exclude antigenic stimulation and topical corticosteroids to control Th2-mediated tissue inflammation and pathologic remodeling. Dilation as a rescue therapy for the narrowed, fibrostenotic, symptomatic esophagus can potentially be avoided with optimal medical and elimination diet therapies. The molecular mechanisms underlying EoE pathogenesis are being unraveled, from which targeted therapies can be developed and evaluated in pre-clinical and clinical studies. Current clinical research efforts focus on optimization of topical corticosteroid delivery, dosing, frequency, and duration of treatment, either alone or in combination with tailored elimination diet. Preliminary clinical trials with biologics targeting IL-5 and IL-13/IL-4 have been completed.ConclusionsTopical corticosteroid, elimination diet, and dilation are the current treatment modalities for confirmed EoE. The use of proton-pump inhibitors (PPI) is being suggested as a potential regimen to treat EoE, based on evolving understanding of PPI-responsive esophageal eosinophilia (PPI-REE). The complexity of EoE treatment regimens and frequent follow ups require a multimodal, multi-disciplinary management approach to optimize patient care.



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