Treatment goals in eosinophilic esophagitis: Looking beyond eosinophil count

Umeweni, Chizoba N.; Ruffner, Melanie A.; Verma, Kanak

doi:10.1016/j.anai.2022.08.001

Cited by 3 publications

(2 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Esophageal biopsy with eosinophil count per high-power field is the gold standard for histologic diagnosis of EoE. Eosinophil count and dysphagia questionnaires are the primary endpoints used in clinical trials for EoE therapies; however, these methodologies have been called into question recently as the sole measure for diagnosis and treatment response (21,22). For instance, the dupilumab clinical trial demonstrated that although both weekly and biweekly injections demonstrated similar response rates, only weekly therapy provided symptomatic improvement (23).…”

Section: Discussionmentioning

confidence: 99%

Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis

Kennedy,

Umeweni,

Alston

et al. 2024

Am J Gastroenterol

Self Cite

View full text Add to dashboard Cite

Background: There is limited data characterizing eating habits among pediatric patients with EoE. We compared eating behaviors in pediatric EoE patients with healthy controls, and assessed the degree of correlation with symptomatology, endoscopic and histologic findings, and esophageal distensibility. Methods: We conducted a prospective, observational study where subjects consumed four food textures (puree, soft solid, chewable, and hard solid), and were scored for eating behaviors including number of chews per bite, sips of fluid per food, and consumption time. Symptomatic, endoscopic, histologic, and esophageal distensibility data was collected for case subjects. Results: Twenty-seven case subjects and 25 healthy controls were enrolled in our study (mean age 11.0 years, 63.5% male). Compared with healthy controls, pediatric EoE patients demonstrated more chews per bite with soft solid (13.6 vs 9.1, p=0.031), chewable (14.7 vs 10.7, p=0.047), and hard solid foods (19.0 vs 12.8, p=0.037). EoE patients also demonstrated increased consumption time with soft solid (94.7 vs 58.3 seconds, p=0.002), chewable (90.0 vs 65.1 seconds, p=0.005), and hard solid foods (114.1 vs 76.4 seconds, p=0.034) when compared to healthy controls. Subgroup analysis based on disease status showed no statistically significant differences in eating behaviors between active and inactive EoE. Total EREFS score positively correlated with consumption time (r 0.53, p = 0.008) and number of chews (r 0.45, p = 0.027) for chewable foods and with number of chews (r 0.44, p = 0.043) for hard solid foods. Increased consumption time correlated with increased eosinophil count (r 0.42, p=0.050) and decreased esophageal distensibility (r -0.82, p<0.0001). Discussion: Altered eating behaviors including increased chewing and increased consumption time can be seen in pediatric patients with EoE, can persist despite histologic remission, and may be driven by changes in esophageal distensibility.

show abstract

Section: Discussionmentioning

confidence: 99%

Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis

Kennedy,

Umeweni,

Alston

et al. 2024

Am J Gastroenterol

Self Cite

View full text Add to dashboard Cite

show abstract

“…Prior to the development of targeted biological therapy for allergic diseases, the goals of treatment were the reduction of symptoms and flares/complications and the restoration or maintenance of function in the affected organ [ 1 – 5 ]. Biological therapy has revolutionized the treatment of many chronic inflammatory diseases, including psoriasis, rheumatoid arthritis, and inflammatory bowel disease, allowing for the development of a “treat-to-target” approach that ultimately aims at achieving and maintaining the target (remission) in many patients [ 6 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Remission in Type 2 Inflammatory Diseases: Current Evidence, Unmet Needs, and Suggestions for Defining Remission in Chronic Rhinosinusitis with Nasal Polyps

Caminati,

De Corso,

Ottaviano

et al. 2023

Curr Allergy Asthma Rep

View full text Add to dashboard Cite

Purpose of Review The development of biological therapies for type 2 inflammatory diseases raises the possibility of addressing remission in those dis-immune conditions. No consensus exists for a definition of remission in chronic rhinosinusitis with nasal polyps (CRSwNP). This review aims to critically evaluate the published data to provide the basis for defining remission in CRSwNP. Recent Findings The published evidence has yet to provide an unequivocal definition on remission in type 2 inflammatory diseases, in part reflecting differences in approaches to diagnosis and follow-up. A multidimensional evaluation is necessary when considering complete remission, including clinical, inflammatory, and histologic criteria, but how to combine or tailor the three perspectives according to disease severity at baseline or timing of assessment of treatment category is yet to reach consensus. We suggest defining remission starting from the approach taken in asthma and eosinophilic esophagitis, that is, including the resolution of symptoms and improvements in objective parameters of disease severity and/or inflammatory activity. Future studies and consensuses should provide validated criteria with cutoffs for the day-to-day definition of remission. Summary The definition of remission in CRSwNP should include the following criteria, to be verified and maintained for a period of ≥ 12 months: absence of symptoms (nasal obstruction, loss of smell, rhinorrhea as the main ones); no impact of symptoms on quality of life; no need of surgery; no chronic or rescue medications (systemic corticosteroids or antibiotics); and recovery of smell function, possibly evaluated by objective test. Assessment of underlying inflammation should also be considered once accurate and feasible biomarkers are available in clinical practice.

show abstract

Eosinophilic esophagitis

Spergel¹

2023

Annals of Allergy, Asthma & Immunology

View full text Add to dashboard Cite

Treatment goals in eosinophilic esophagitis: Looking beyond eosinophil count

Cited by 3 publications

References 6 publications

Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis

Esophageal Remodeling Correlates With Eating Behaviors in Pediatric Eosinophilic Esophagitis

Remission in Type 2 Inflammatory Diseases: Current Evidence, Unmet Needs, and Suggestions for Defining Remission in Chronic Rhinosinusitis with Nasal Polyps

Eosinophilic esophagitis

Contact Info

Product

Resources

About