A Conceptual Approach to Understanding Treatment Response in Eosinophilic Esophagitis

Dellon, Evan S.; Gupta, Sandeep K.

doi:10.1016/j.cgh.2019.01.030

Cited by 71 publications

(56 citation statements)

References 153 publications

(195 reference statements)

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“…In monitoring treatment, a system has been proposed that evaluates response along a spectrum that includes complete normalization, response, and nonresponse, based on histology, symptoms, and endoscopic findings[117] (Table 1).…”

Section: Monitoringmentioning

confidence: 99%

Eosinophilic esophagitis: Current concepts in diagnosis and treatment

Aldana¹,

Jaramillo-Santos²,

Delgado³

et al. 2019

WJG

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Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. Its symptoms, which include heartburn, regurgitation, and esophageal stenosis (with dysphagia being more frequent in eosinophilic esophagitis in young adults and children), are similar to those of gastroesophageal reflux disease, causing delays in diagnosis and treatment. Although endoscopic findings such as furrows, esophageal mucosa trachealization, and whitish exudates may suggest its presence, this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia (parasitic infections, hypereosinophilic syndrome, inflammatory bowel disease, among others) for which treatment could be initiated. Currently, the 3 “D”s (“Drugs, Diet, and Dilation”) are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. Herein, the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed, in addition to evidence for the various treatments.

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Section: Monitoringmentioning

confidence: 99%

Eosinophilic esophagitis: Current concepts in diagnosis and treatment

Aldana¹,

Jaramillo-Santos²,

Delgado³

et al. 2019

WJG

View full text Add to dashboard Cite

show abstract

“…41 This inconsistency in PECs has been attributed to number of factors, including the patchy nature of EoE, variability in selection of areas of high eosinophilia, number of areas examined, and microscope HPF size. 17,42,43 PEC has been widely used as an outcome tool in clinical trials, yet, there is no consensus definition for treatment response, which is variable in published studies. [44][45][46] Eosinophilia is only one of the consequences of the EoE-associated T H 2 response, the others being esophageal remodeling and loss of barrier function.…”

Section: Should We Move Past Peak Eosinophil Count and Use The Eoe Himentioning

confidence: 99%

“…15,16 Recently, a new, more comprehensive histology score was developed that performs better than current measures and is highly sensitive to treatment. 17 The focus of this review is to provide updates on key unanswered questions in the diagnosis and management of EoE.…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic esophagitis: updates on key unanswered questions

Fernandez‐Becker

Raja

Scarpignato

et al. 2020

Annals of the New York Academy of Sciences

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Eosinophilic esophagitis (EoE) is a clinicopathologic disease characterized by symptoms of esophageal dysfunction and esophageal eosinophilia. In the last decade, there has been a dramatic increase in its prevalence for reasons that are not completely understood. The underlying pathophysiology involves an antigen‐mediated TH2 immune response that draws eosinophils to the esophagus, causing mucosal inflammation, esophageal remodeling, and fibrosis. This ultimately leads to esophageal dysfunction that most commonly manifests as dysphagia. In this review, we will discuss updates on key questions regarding the diagnosis and treatment of EoE.

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“…4 A new framework for treatment response in EoE has recently proposed histology, symptom and endoscopy parameters for three categories of EoE resolution; nonresponse, response, and complete normalization. 20 Whilst there are reviews of the literature on the effectiveness of the various dietary options in pediatric EoE, [21][22][23] there is little analysis on the effectiveness of the ED (using AAF) in pediatric EoE. The aim of this narrative review was therefore to explore the effectiveness of the use of AAF in the management of pediatric EoE.…”

Section: Introductionmentioning

confidence: 99%

The use of amino acid‐based nutritional feeds is effective in the dietary management of pediatric eosinophilic oesophagitis

Atwal

Hubbard

Venter

et al. 2019

Immunity Inflam & Disease

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Introduction Eosinophilic oesophagitis (EoE) is an immune‐mediated, chronic disease characterized by eosinophilic inflammation and esophageal dysfunction. Specific food allergens including cow's milk protein, are partially causative to disease progression, and dietary management forms three main options; the elemental diet (ED), the empirical elimination diet (EED), and the targeted elimination diet (TED). The dietary choice should be individualized, however, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines recommend an ED for pediatric EoE with multiple food allergies, failure to thrive, unresponsive disease or unable to follow a highly restricted diet. The aim of this narrative review was to explore the effectiveness of the ED (using amino acid formula [AAF]), in the management of pediatric EoE. Methods Literature searches were performed to identify eligible studies that described outcomes including eosinophil count, clinical symptoms, growth, and medications. Results Overall, 10 eligible studies were found, with n = 462 patients assigned to receive AAF from a total of n = 748 (average age 6.7 years), for a duration of 4 to 8 weeks. The use of AAF reduced eosinophil levels and demonstrated remission (defined as ≤10 eosinophils per high power field) in 75%‐100% of children with improvements, if not resolution, in clinical symptoms. AAF was more clinically effective than the use of the EED or TED, where remission rates were 75%‐81% and 40%‐69%, respectively. Few studies collected growth outcomes, however where documented these were positive for those on AAF. The long‐term impacts of each diet were not thoroughly explored. Conclusions The use of AAF is a clinically effective management option for pediatric EoE, and further research is required to guide long‐term management.

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A Conceptual Approach to Understanding Treatment Response in Eosinophilic Esophagitis

Cited by 71 publications

References 153 publications

Eosinophilic esophagitis: Current concepts in diagnosis and treatment

Eosinophilic esophagitis: Current concepts in diagnosis and treatment

Eosinophilic esophagitis: updates on key unanswered questions

The use of amino acid‐based nutritional feeds is effective in the dietary management of pediatric eosinophilic oesophagitis

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