Eosinophilic Esophagitis

Twenty years have passed since eosinophilic esophagitis was first recognized as a new and distinct entity. Current treatment modalities for eosinophilic esophagitis include the “3 Ds”: drugs, allergen avoidance with diet, and esophageal dilation. Drugs entail the limitation that only corticosteroids have a proven efficacy; most other compounds evoke only a minimal effect. Diets must be maintained continuously and they interfere markedly with the quality of life, possibly even involving some risk of malnutrition. A greater understanding of the immunopathogenesis, natural history, and disease spectrum will inevitably lead to improved therapeutic outcomes for this emerging entity.

Key points

•

Twenty years have passed since eosinophilic esophagitis was first recognized as a new and distinct entity; this time span has been long enough for research to ascertain several fundamental principles, and also long enough to pose certain critical questions regarding the diagnosis, therapy, and long-term management of this disease.
•

In eosinophilic esophagitis, several therapeutic modalities are available but all have important limitations; there is thus an urgent need for alternative treatment options.
•

With respect to medications, second-generation CRTH2 antagonists and biologicals targeting IL-13 and/or IL-4 are promising candidates.
•

As for dietary treatment, there is hope that a simplified induction regimen, more accurate allergy tests to identify causative food antigens, as well as an individualized maintenance diet will increase the utilization of the dietary approach.