Medical and dietary management of eosinophilic esophagitis

Nhu, Quan M.; Aceves, Seema S.

doi:10.1016/j.anai.2018.05.006

Cited by 30 publications

(24 citation statements)

References 88 publications

(114 reference statements)

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“…Generally, the positive predictive values fall in the 44% range. 47,53 Additional methodologies, including serum IgE testing, patch testing, and component-resolved diagnosis, have been attempted but have not been successful in pinpointing triggering food antigens. 54,55 Despite this, skin prick testing to foods should be considered, especially in children.…”

Section: Allergy Testing-directed Elimination Dietmentioning

confidence: 99%

Diagnosis and treatment of eosinophilic esophagitis

Gonsalves

Aceves

2020

Journal of Allergy and Clinical Immunology

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129

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Section: Allergy Testing-directed Elimination Dietmentioning

confidence: 99%

Diagnosis and treatment of eosinophilic esophagitis

Gonsalves

Aceves

2020

Journal of Allergy and Clinical Immunology

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129

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“…Endoscopic dilation is used for patients with severe dysphagia/food impaction with inadequate response to anti-inflammatory treatment. The complexity of EoE treatment regimens and frequent follow-ups require a multimodal, multidisciplinary management approach to optimize patient care ( 147 ).…”

Section: Natural History and Prognosismentioning

confidence: 99%

Eosinophilic Esophagitis: Review and Update

et al. 2018

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Background: Eosinophilic esophagitis (EoE) was first described in the 1990s, showing an increasing incidence and prevalence since then, being the leading cause of food impaction and the major cause of dysphagia. Probably, in a few years, EoE may no longer be considered a rare disease.Methods: This article discusses new aspects of the pathogenesis, symptoms, diagnosis, and treatment of EoE according to the last published guidelines.Results: The epidemiological studies indicate a multifactorial origin for EoE, where environmental and genetic factors take part. EoE affects both children and adults and it is frequently associated with atopic disease and IgE-mediated food allergies. In patients undergoing oral immunotherapy for desensitization from IgE-mediated food allergy the risk of developing EoE is 2.72%. Barrier dysfunction and T-helper 2 inflammation is considered to be pathogenetically important factors. There are different patterns of clinical presentation varying with age and can be masked by adaptation habits. Besides, symptoms do not usually correlate with histologic disease activity. The diagnostic criteria for EoE has evolved but mainly requires symptoms of esophageal dysfunction with histologic evidence of a peak value of at least 15 eosinophils per high-power field. Endoscopies have to be repeated in order to diagnose, monitor, and treat EoE. Treatment of EoE can be started either by drugs (PPIs and topical corticosteroids) or elimination diets. The multistage step-up elimination diet management approach of EoE is promising. Endoscopic dilation is used for patients with severe dysphagia/food impaction with inadequate response to anti-inflammatory treatment.Conclusions: Research in recent years has contributed to a better understanding of EoE's pathogenesis, genetic background, natural history, allergy workup, standardization in assessment of disease activity, evaluation of minimally invasive diagnostic tools, and new therapeutic approaches. However, several unmet needs are to be solved urgently, as finding a non-invasive disease-monitoring methods and biomarkers for routine practice, the development or new therapies, novel food allergy testing to detect triggering foods, drug, and doses required for initial therapy and safety issues with long-term maintenance therapy, amongst others. Besides, multidisciplinary management units of EoE, involving gastroenterologists, pediatricians, allergists, pathologists, dietitians, and ENT specialists are needed.

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“…There are currently no drugs approved by the Food and Drug Administration (FDA) for the treatment of EoE. The complexity of current EoE management requires a multimodal, multidisciplinary approach that includes chronic corticosteroid treatment, proton-pump inhibitors (PPI), dietary antigen restriction, lifestyle modification, and repeated endoscopic diagnostic and therapeutic evaluations [25,62]. Several biologic agents are being investigated for the management of EoE.…”

Section: Treatment Of Eoementioning

confidence: 99%

New Developments in the Diagnosis and Treatment of Eosinophilic Esophagitis

Nhu

Moawad

2019

Curr Treat Options Gastro

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Purpose of Review: Eosinophilic esophagitis (EoE) is a chronic, allergen-driven, immunemediated disease of the esophagus that progresses to esophageal fibrostenosis if left untreated. The aim of this review is to provide a concise update on recent clinically relevant advances in the development of diagnostic and therapeutic approaches for EoE. Recent Findings-Current diagnostic and disease monitoring protocols for EoE rely on repetitive endoscopic evaluations and esophageal tissue acquisition for histopathologic analysis. Recent advancements in EoE diagnosis include endoscopic functional lumen imaging probe (FLIP), transnasal endoscopy (TNE), and the emergence of non-invasive diagnostic tools including cytosponge, esophageal string test, and mucosal impedance probe. Biomarkers for EoE have not yet proven their clinical utility. No Food and Drug Administration (FDA)-approved drugs currently exist for the treatment of EoE. Topical corticosteroid, proton-pump inhibitors (PPI), elimination diet, and dilation are the current treatment modalities for confirmed EoE. Promising results from clinical trials are emerging for biologic agents that target the interleukin (IL)-13 and the IL-4/IL-13 receptor, specifically, RPC4046 and dupilumab, respectively. Summary-New diagnostic algorithms, non-invasive diagnostic strategies, and treatment modalities for EoE are emerging. Patients with EoE continue to require a multimodal and multidisciplinary management approach.

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Medical and dietary management of eosinophilic esophagitis

Cited by 30 publications

References 88 publications

Diagnosis and treatment of eosinophilic esophagitis

Diagnosis and treatment of eosinophilic esophagitis

Eosinophilic Esophagitis: Review and Update

New Developments in the Diagnosis and Treatment of Eosinophilic Esophagitis

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