Disease Burden and Unmet Need in Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease of increasing prevalence, characterized by symptoms of dysphagia and reduced quality of life. A dysregulated type 2 immune response to food and aeroallergen leads to barrier dysfunction, chronic esophageal inflammation, remodeling, and fibrosis. Patients with EoE have impaired quality of life because of dysphagia and other symptoms. They may also suffer social and psychological implications of food-related illness and expensive out-of-pocket costs associated with treatment. Disease burden in EoE is often compounded by the presence of comorbid type 2 inflammatory diseases. Current conventional treatments include elimination diet, proton pump inhibitors, and swallowed topical corticosteroids, as well as esophageal dilation in patients who have developed strictures. These treatments demonstrate variable response rates and may not always provide long-term disease control. There is an unmet need for long-term histologic, endoscopic, and symptomatic disease control; for targeted therapies that can normalize the immune response to triggers, reduce chronic inflammation, and limit or prevent remodeling and fibrosis; and for earlier diagnosis, defined treatment outcomes, and a greater understanding of patient perspectives on treatment. In addition, healthcare professionals need a better understanding of the patient perspective on disease burden, the disconnect between symptoms and disease activity, and the progressive nature of EoE and the need for continuous monitoring and maintenance treatment. In this review, we explore the progression of disease over the patient's lifespan, highlight the patient perspective on disease, and discuss the unmet need for effective long-term treatments.

The Role of Benralizumab in Eosinophilic Immune Dysfunctions: A Case Report-Based Literature Review

“…In the United Kingdom, although the prevalence of severe, uncontrolled eosinophilic asthma is low (1%), the associated health-related costs are four times greater (cost ratio 3.9 (95% IC 3.7-4.1)) [16]. Moreover, healthcare resource utilization may be particularly high in EGID, with contributing factors including diagnostic delays (poor disease recognition), repeated endoscopy, and lack of approved medications [11,17,18]. Te median total annual cost of a single eosinophilic esophagitis case in the United States was estimated at USD $3,300 (outpatient visits, pharmacy, and endoscopy); the total health utilization costs per year vary between $350 and 950 million [19][20][21][22].…”

A real-world characterization of a cohort with eosinophilic esophagitis: looking for severity biomarkers

“…There are some patients who may respond to treatment with endoscopic dilation, which will reduce the risk of future food impaction, but there is no associated benefit in terms of improving histological eosinophilia (10). Whenever possible, treatment should be oriented by a multidisciplinary team, consisting of a gastroenterologist, immunoallergologist and nutritionist for assessment of diet feasibility and nutritional follow-up (12,13).…”

“…Severe clinical disease was defined based on our clinical practice as presence of symptoms with a significant impact on quality of life and/or ≥ 1 visit to the Emergency Department and/or hospitalization due to EoE complications, namely severe dysphagia, food impaction and/or esophageal perforation due to the progression of esophageal stricture. In the present study, the burden of disease on quality of life was subjectively assessed as reported by the patient and/or families in 3 domains, including emotional distress, limited normal feeding and restricted social activities, as the scores currently available for this assessment are not validated for Portuguese (9,10). The criteria for defining EoE complications were adapted from Furuta GT et al (18) and Gomez Torrijos E et al (19).…”

“…It can be presumed that the detection of both humoral and cellular sensitization to food allergens and the food elimination of all allergens with positive results from any of the allergy methods offers an increased PPV. Considering these results and once difficulties in patients' compliance with empirical avoidance diets are real and frequently observed in our clinical practice, we think that allergy tests, SPT and APT, may continue to be considered, especially in children, as a complement to first-line pharmacological therapy (swallowed corticosteroids and/or PPI) and not as a replacement for it (10,24). Additionally, SPT are particularly important to confirm or exclude the suspected diagnosis of concomitant IgE-mediated food allergy (25).…”

“…In contrast, children present more commonly with vomiting, heartburn, regurgitation, emesis, and abdominal pain (5,8). It is known that EoE may negatively affect the quality of life of patients and their families because of symptoms limiting normal feeding, with many patients reporting social and psychological implications of food-related illness (9,10).…”