Current and Novel Therapies for Eosinophilic Gastrointestinal Diseases

Abstract

Eosinophilic gastrointestinal diseases (EGIDs) are an emerging group of pathological entities characterized by an eosinophil-predominant infiltration of different tracts of the gut in the absence of secondary causes of eosinophilia. According to the specific tract of the gut involved, EGIDs can be classified into eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The epidemiology of EGIDs is evolving rapidly. EoE, once considered a rare disease, now has an incidence and prevalence of 7.7 new cases per 100,000 inhabitants per years and 34.4 cases per 100,000 inhabitants per year, respectively. Fewer data are available regarding non-EoE EGIDs, whose prevalence are estimated to range between 2.1 and 17.6 in 100,000 individuals, depending on age, sex, and ethnicity. Diagnosis requires the presence of suggestive symptoms, endoscopic biopsies showing abnormal values of eosinophils infiltrating the gut, and exclusion of secondary causes of eosinophilia. EoE typically presents with dysphagia and episodes of food bolus impactions, while EoG, EoN, and EoC may all present with abdominal pain and diarrhea, with or without other non-specific symptoms. In addition, although different EGIDs are currently classified as different entities, there may be overlap between different diseases in the same patient. Despite EGIDs being relatively novel pathological entities, the research on possible treatments is rapidly growing. In this regard, several randomized controlled trials are currently ongoing to investigate novel molecules, including ad-hoc steroid formulations, immunosuppressants, and mostly monoclonal antibodies that target the specific molecular mediators of EGIDs. This narrative review provides an up-to-date overview of available and investigational drugs for different EGIDs.

A Review of Non-IgE Immune-Mediated Allergic Disorders of the Gastrointestinal Tract

“…These include eosinophilic gastritis (EoG), eosinophilic esophagitis (EoE), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC), where chronic eosinophilic inflammation subsequently leads to gut dysfunction and structural changes [51]. The epidemiology of these conditions is rapidly changing, and various treatment modalities are being investigated with the aim of targeting the mediators of these conditions [52].…”

Challenges in Diagnosis and Management of Unusual Cases of Eosinophilic Enteritis in Rural Health Settings: A Comprehensive Review

“…Proton pump inhibitors (PPIs): PPIs are employed in treating EGE by reducing acid production in the stomach [28]. This approach aims to modulate the acidic environment within the GI tract, addressing one of the contributing factors to inflammation.…”

“…Biologic therapies: For specific individuals with EoE, biologic therapies represent a valuable treatment option. These therapies target specific molecules involved in the inflammatory response, such as interleukin-5 (IL-5) or interleukin-13 (IL-13) [28]. By precisely modulating these inflammatory pathways, biological therapies offer a targeted and practical approach to managing the underlying causes of EoE.…”

Improved Outcomes in Eosinophilic Esophagitis with Higher Medication Possession Ratio

“…TS use in EoE is more effective than the use of PPIs, but is largely limited to oral viscous budesonide and swallowed fluticasone [1,5]. Very recently, biologic medications able to treat EoE, such as Dupilimab, have been approved by the United States Food and Drug Administration [8][9][10]. Elimination diets have also been used with success to treat EoE [1,5,10].…”

“…Very recently, biologic medications able to treat EoE, such as Dupilimab, have been approved by the United States Food and Drug Administration [8][9][10]. Elimination diets have also been used with success to treat EoE [1,5,10]. While variability in the practice of EoE management among gastroenterologists has been well documented, PPIs and TSs remain the most-common recommendations for first-line treatment, respectively [11].…”