From the Guidelines
Evaluation and management of eosinophilic esophagitis (EoE) should follow the comprehensive guidelines provided by the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition, which emphasize a multidisciplinary approach to diagnosis, treatment, and management 1.
Key Components of EoE Management
- Initial evaluation should include upper endoscopy with multiple biopsies to confirm the diagnosis, established by finding ≥15 eosinophils per high-power field in esophageal mucosa after excluding other causes of eosinophilia.
- First-line treatment options include proton pump inhibitors, topical steroids, or dietary therapy, with the choice of treatment depending on patient-specific factors and the severity of symptoms.
- For patients with severe dysphagia or food impaction, endoscopic dilation may be necessary, and maintenance therapy is typically required as EoE is a chronic condition.
Treatment Goals and Follow-Up
- Treatment goals include symptom improvement, histological remission, and prevention of complications such as esophageal strictures.
- Follow-up endoscopy with biopsies is recommended after 8-12 weeks of therapy to assess histological response, and dose reduction of medications is possible after initial response.
- The pathophysiology of EoE involves immune-mediated inflammation triggered by food allergens or environmental factors in genetically predisposed individuals, leading to esophageal remodeling if left untreated, as supported by recent clinical guidelines 1.
Prioritizing Patient Care
- The management of EoE should prioritize morbidity, mortality, and quality of life, with a focus on individualized treatment plans and regular follow-up to monitor disease progression and adjust therapy as needed.
- The use of novel, targeted biologic therapies for EoE is being actively evaluated, and a deeper understanding of the natural history of EoE in both children and adults is needed to inform clinical decisions regarding the optimal use of disease monitoring and long-term, maintenance therapy 1.
From the Research
Evaluation and Management of Eosinophilic Esophagitis (EoE)
- EoE is a chronic inflammatory condition of the esophagus, characterized by symptoms of esophageal dysfunction and an eosinophilic predominant infiltrate in the esophagus 2, 3, 4.
- The diagnosis of EoE is based on a combination of clinical symptoms, endoscopic findings, and histologic evidence of eosinophilic infiltration 3, 4.
- Treatment options for EoE include:
- Topical glucocorticosteroids, which have been shown to effectively reduce esophageal eosinophil counts over a short-term treatment period 2.
- Dietary strategies, such as elemental diets and empiric food elimination diets, which may be effective in reducing esophageal eosinophil counts 2, 3, 5.
- Proton pump inhibitors (PPIs), which may be associated with a histologic response in some patients 3, 5, 4.
- Esophageal dilation, which may be necessary for patients with symptomatic esophageal narrowing 3, 4.
- Combination therapy, such as the use of PPIs and food elimination diet, may be effective in inducing histologic remission in patients with EoE refractory to monotherapy 5.
- Monitoring and assessment of treatment response typically requires endoscopy with biopsy, as well as clinical and histologic assessments 2, 3, 4.
- The American College of Gastroenterology Clinical Guideline recommends a multidisciplinary approach to the diagnosis and management of EoE, including the use of validated outcome metrics and consideration of both the inflammatory and fibrostenotic aspects of disease 4, 6.