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New Developments in the Diagnosis and Treatment of Eosinophilic Esophagitis

Current Treatment Options in Gastroenterology volume 17, pages 48–62 (2019)Cite this article

Abstract

Purpose of review

Eosinophilic esophagitis (EoE) is a chronic, allergen-driven, immune-mediated 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 multi-disciplinary management approach.

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Abbreviations

AEC:

Absolute eosinophil count

EoE:

Eosinophilic esophagitis

FLIP:

Functional lumen imaging probe

FFED:

Four-food elimination diet

hpf:

High-power field

PPI:

Proton-pump inhibitor

PPI-REE:

PPI-responsive esophageal eosinophilia

SFED:

Six-food elimination diet

TFED:

Two-food elimination diet

TNE:

Transnasal endoscopy

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Funding

QMN is supported by Scripps Research Translational Institute NIH/NCATS CTSA Award 5 UL1 TR001114, 5KL2 TR001112, and by a CEGIR award. CEGIR (Consortium of Eosinophilic Gastrointestinal Disease Researchers; U54 AI117804) is part of the Rare Disease Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including APFED, CURED, and EFC. QMN and FJMare supported by Scripps Clinic and by Scripps ClinicMedical Group Research & Education Awards.

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  1. Division of Gastroenterology & Hepatology, Scripps Clinic, 10666 N. Torrey Pines Road, Suite 203N, La Jolla, CA, 92037, USA

    Quan M. Nhu MD, PhD & Fouad J. Moawad MD

  2. Scripps Research Translational Institute, The Scripps Research Institute, La Jolla, CA, USA

    Quan M. Nhu MD, PhD

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Nhu, Q.M., Moawad, F.J. New Developments in the Diagnosis and Treatment of Eosinophilic Esophagitis. Curr Treat Options Gastro 17, 48–62 (2019). https://doi.org/10.1007/s11938-019-00216-7

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Keywords

  • Eosinophilic esophagitis (EoE)
  • Diagnosis
  • Treatment
  • Corticosteroids
  • Elimination diet
  • Biologic therapy