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Eosinophilic Esophagitis in Children

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Abstract

Eosinophilic esophagitis (EoE) is a relatively common chronic immune-mediated disease of the esophagus characterized clinically by symptoms of esophageal dysfunction that vary by age. Histologically, EoE results in marked esophageal eosinophilia despite treatment with high-dose proton pump inhibition. The cornerstone of treatment is dietary restriction and/or pharmacologic therapy, mainly with topical steroids. This review briefly describes dietary therapy, but focuses on the various medical options in the treatment of EoE, with an emphasis on steroid-based therapy. Numerous landmark studies are reviewed describing the symptomatic and histologic endpoints as well as safety data. The literature strongly supports the use of topical steroid therapy as a means of significantly decreasing eosinophilic mucosal disease. Specifically, high-dose fluticasone propionate appears to be very effective, and has been shown to result in the resolution of mucosal eosinophilia in a large percentage of treated patients. Long-term studies over many years will need to determine whether mucosal healing will change the natural history of this stricture-causing disease. In addition to topical therapy, various other drug-based therapies are reported, including newer immune-based monoclonal antibodies.

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Conflict of interest

Prerna Trivedy, MD, and Jonathan E. Teitelbaum, MD, have no relevant conflicts of interest.

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Authors and Affiliations

  1. The Unterberg Children’s Hospital at Monmouth Medical Center, Long Branch, NJ, USA

    Prerna Trivedy

  2. Pediatric Gastroenterology, Department of Pediatrics, The Unterberg Children’s Hospital at Monmouth Medical Center, 300 Second Avenue, Long Branch, NJ, 07740, USA

    Jonathan E. Teitelbaum

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  1. Prerna Trivedy
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  2. Jonathan E. Teitelbaum
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Correspondence to Jonathan E. Teitelbaum.

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Trivedy, P., Teitelbaum, J.E. Eosinophilic Esophagitis in Children. Pediatr Drugs 17, 227–237 (2015). https://doi.org/10.1007/s40272-015-0126-4

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