Eosinophilic esophagitis: management and pharmacotherapy

Abstract

Eosinophilic esophagitis represents the most debated disease of the last 10 years, too often speculated or overestimated and certainly well known and examined. The aim of this study was to summarize the recent therapeutic trends in order to show persistent doubts regarding several debated therapies. The study combined the most recent international literature and the authors' daily experience to define the scope of the review, with limits caused by a lack of available randomized studies between dietetic and pharmacological treatment. It was concluded that eosinophilic esophagitis is an immunoallergic disease that is generally caused by identifiable food and environmental allergens although, in a minority of cases, the etiological trigger remains undetermined. Therapy usually fights the responsible agents, but sometimes they are not resolved. A need for more pathogenetically driven treatments is invoked.

Profile of reslizumab in eosinophilic disease and its potential in the treatment of poorly controlled eosinophilic asthma

“…Eosinophils are absent from the healthy esophagus, and EE is characterized by a marked mucosal eosinophil accumulation with a count of more than 15 cells per high power field, which is considered diagnostic for this condition. EE is widely seen as an idiopathic condition, reflecting the rather poor understanding of the underlying pathogenic mechanisms 27. It is thought that a marked Th2-driven component in response to both food and environmental allergens drives the accumulation of eosinophils in the esophageal mucosa.…”

Mepolizumab and Eosinophil-Mediated Disease

“…EE is a relatively newly recognized disease that demonstrates a strong association with allergic disease. It is widely seen as an idiopathic condition reflecting the rather poor understanding of the underlying pathogenic mechanisms [39]. A marked Th2-driven component drives accumulation of eosinophils in the esophageal mucosa and it is thought that enhanced production of Th2-associated cytokines is in response to both food and environmental allergens.…”

Monoclonal Antibody-Based Therapy for Eosinophilic Oesophagitis

“…It also has a strong (70%) gender predisposition for males 2 and an association with allergic disease often manifested by reactivity to both food and aeroallergens. [3][4][5][6] Eosinophils are absent from the normal oesophagus; EoE is characterised by a marked mucosal eosinophil accumulation, with a count of >15 cells per microscopic high-power field considered diagnostic for this condition. It was initially seen as an idiopathic condition reflecting the rather poor understanding of the underlying pathogenic mechanisms.…”

“…It was initially seen as an idiopathic condition reflecting the rather poor understanding of the underlying pathogenic mechanisms. 3 It is now apparent that EoE is in fact a complex disease with major contributions made by genetic predisposition, environmental exposure, allergen sensitisation, and involvement of other cells and mediators in addition to eosinophils that, in turn, greatly influence therapeutic approaches. 4 Eosinophilic gastroenteritis (EG) is a similar disease, characterised by eosinophilic infiltration of the gastrointestinal (GI) tract resulting in variable clinical GI pathology.…”