Medical treatment of eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the oesophagus first described in the 1970s. 1 All ages can be affected; however, it is more common in males and adults. Estimates of incidence in Europe and the United States range from 1.3 to 12.8 cases per 100,000. 2Presenting symptoms vary widely between patients, including dysphagia, pain and food bolus impaction/obstruction. 1-3 EoE often coexists with other atopic diseases, and evidence supports an underlying mechanism of type-2 inflammatory response to food antigens. 1,2 Diagnosis is made with a peak eosinophil count of ≥15 eosinophils/0.3 mm 2 on oesophageal histology. 1,3 Recently, a group in France published on their automated, accurate and reproducible method to assess eosinophilic density and degree of degranulation, which poses time-saving advantages. 4 Treatment of EoE is lifelong, aiming to prevent fibrostenosis and strictures. 3 Elimination diets and corticosteroids have been used for many years, and biologics are now available for some patients. This Cochrane Corner will summarize the effectiveness and safety of medical interventions for people with EoE and put these in a useful, clinical context for the practising clinician.