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. 2014 Feb;10(2):106-16.

Emerging therapeutic options for eosinophilic esophagitis

Timothy Dougherty Jr  1 , Sindu Stephen  1 , Marie L Borum  1 , David B Doman  1
Affiliations

Emerging therapeutic options for eosinophilic esophagitis

Timothy Dougherty Jr et al. Gastroenterol Hepatol (N Y). 2014 Feb.

Abstract

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that often occurs in atopic persons. Management strategies include pharmacotherapy, dietary modification, and endoscopic therapy, although patients will often have a relapsing and remitting course. Currently, the primary pharmacotherapy for EoE consists of corticosteroids. Immuno-modulators, leukotriene antagonists, biologies, and monoclonal antibodies are currently under study for treatment of EoE. The role of immunoglobulin E-mediated allergic reactions has been well documented and may provide insight into the etiology and effective therapy of EoE.

Keywords: Eosinophilic esophagitis; proton pump inhibitor—responsive esophageal eosinophilia; reflux esophagitis.

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Figures

Figure 1
Figure 1
A 30-year-old man with allergic rhinitis and a history of food impaction presented to the emergency department complaining of food impacted in the esophagus. An upper endoscopy revealed concentric rings (A) and a bolus obstructing the midesophagus (B). Biopsies were consistent with eosinophilic esophagitis.
Figure 2
Figure 2
A 23-year-old man with a history of food impaction and episodic dysphagia requested evaluation. An esophagogastroduodenoscopy was notable for linear furrows as well as friable, “crepe paper” mucosa. Biopsies revealed numerous intraepithelial eosinophils.
Figure 3
Figure 3
A 37-year-old man presented with recurrent dysphagia despite 8 weeks of proton pump inhibitor therapy. An upper endoscopy was performed. Biopsies revealed more than 15 eosinophils per high-power field and eosinophilic microabscesses, which were consistent with the diagnosis of eosinophilic esophagitis (hematoxylin and eosin stain, 40x magnification).
Figure 4
Figure 4
An algorithm for the management of eosinophilic esophagitis. EoE, eosinophilic esophagitis; PPI, proton pump inhibitor; PPI-REE, proton pump inhibitor–responsive esophageal eosinophilia.
See this image and copyright information in PMC

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