A validated disease-specific symptom-assessment tool for eosinophilic esophagitis (EoE) has yet to be approved by regulatory authorities for use in clinical trials. Relevant end points for daily practice include EoE-related symptoms and esophageal eosinophilic inflammation. Endoscopic features should also be taken into account when establishing a therapy plan. A reasonable clinical goal is to achieve a reduction in EoE-related symptoms and esophageal eosinophilic inflammation. Evidence is increasing to support an anti-inflammatory maintenance therapy, as this can reduce esophageal remodeling. In EoE patients in clinical remission, annual disease monitoring with symptom, endoscopic, and histologic assessments of sustained treatment response is recommended.
Key points
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Recommended therapeutic end points in eosinophilic esophagitis (EoE) include symptoms (eg, dysphagia, chest pain), histologic activity, and endoscopic activity (especially strictures). Symptom assessment should examine meal modification and food-avoidance behaviors.
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Evidence is accumulating that maintenance therapy for EoE, by means of either swallowed topical corticosteroids or elimination diets, leads to a reduction of symptoms and esophageal remodeling processes that are associated with food bolus impactions.
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Esophageal dilation can offer long-lasting symptom improvement for EoE patients with esophageal remodeling not responsive to medical or diet therapy.
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