Current and emerging therapies for eosinophilic esophagitis

Abstract

Background: Eosinophilic esophagitis (EoE) is a Type-2 chronic inflammatory food antigen‐driven disease of the esophagus, characterized by eosinophilic predominant inflammation and a constellation of symptoms. The incidence and prevalence of EoE has increased over the past 2 decades. There is an unmet need for approved less burdensome treatment options. Objective: To describe the underlying pathophysiology and diagnosis of EoE and discuss the currently available treatment options. We also aim to review the new and emerging therapies for EoE. Methods: A search of a medical literature data base was performed for articles that discuss treatment for EoE. Results: A comparison of current therapies showed that dietary elimination, swallowed topical corticosteroids, and proton-pump inhibitor therapy are all effective for different populations. Emerging therapies that were reviewed include new topical corticosteroids and biologics directed against Type 2 inflammation. Conclusion: EoE is a chronic inflammatory disorder that can be debilitating, with long-term sequelae. There are no current approved therapies in the United States. Numerous new treatments are on the horizon. Increasing amounts of data are helping to tailor treatment for each patient. Ultimately, shared decision-making is the best approach to guide treatment choices with patients to manage the ever-increasing burden of this disease.

Eosinophilic Esophagitis—What Do We Know So Far?

“…Unfortunately, being the most comfortable for the patient does not mean that it will guarantee the greatest effectiveness. Studies have shown that for the above-mentioned diets, the highest remission was achieved when six components are eliminated in 50–71% of patients [ 4 , 77 ]. In the case of the diets excluding four and two components, remission was achieved in 46–54 and 43–44% of cases, respectively [ 10 , 77 ].…”

“…Studies have shown that for the above-mentioned diets, the highest remission was achieved when six components are eliminated in 50–71% of patients [ 4 , 77 ]. In the case of the diets excluding four and two components, remission was achieved in 46–54 and 43–44% of cases, respectively [ 10 , 77 ]. Therefore, considering the patient’s habits, a step-up empiric approach to food elimination was proposed, beginning with the two-food elimination diet (2-FED) [ 78 ].…”

“…Therefore, PPIs demonstrate many non-antisecretory activities. The optimal dose in adults is 20–40 mg of omeprazole or an equivalent twice per day for 8 weeks [ 77 ]. The dose can be increased if the response is suboptimal because there is dose–response relationship [ 77 ].…”

“…The optimal dose in adults is 20–40 mg of omeprazole or an equivalent twice per day for 8 weeks [ 77 ]. The dose can be increased if the response is suboptimal because there is dose–response relationship [ 77 ]. Regarding EoE complications, they may contribute to inhibition of dietary protein digestion and development of IgE antibodies in response to those proteins [ 31 ].…”