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Review
. 2023 Oct 13;24(20):15165.
doi: 10.3390/ijms242015165.

Current and Novel Therapies for Eosinophilic Gastrointestinal Diseases

Giovanni Marasco  1   2 , Pierfrancesco Visaggi  3 , Mariagiulia Vassallo  1   2 , Miriam Fiocca  1   2 , Cesare Cremon  1   2 , Maria Raffaella Barbaro  1   2 , Nicola De Bortoli  3 , Massimo Bellini  3 , Vincenzo Stanghellini  1   2 , Edoardo Vincenzo Savarino  4   5 , Giovanni Barbara  1   2
Affiliations
Review

Current and Novel Therapies for Eosinophilic Gastrointestinal Diseases

Giovanni Marasco et al. Int J Mol Sci. .

Abstract

Eosinophilic gastrointestinal diseases (EGIDs) are an emerging group of pathological entities characterized by an eosinophil-predominant infiltration of different tracts of the gut in the absence of secondary causes of eosinophilia. According to the specific tract of the gut involved, EGIDs can be classified into eosinophilic esophagitis (EoE), eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The epidemiology of EGIDs is evolving rapidly. EoE, once considered a rare disease, now has an incidence and prevalence of 7.7 new cases per 100,000 inhabitants per years and 34.4 cases per 100,000 inhabitants per year, respectively. Fewer data are available regarding non-EoE EGIDs, whose prevalence are estimated to range between 2.1 and 17.6 in 100,000 individuals, depending on age, sex, and ethnicity. Diagnosis requires the presence of suggestive symptoms, endoscopic biopsies showing abnormal values of eosinophils infiltrating the gut, and exclusion of secondary causes of eosinophilia. EoE typically presents with dysphagia and episodes of food bolus impactions, while EoG, EoN, and EoC may all present with abdominal pain and diarrhea, with or without other non-specific symptoms. In addition, although different EGIDs are currently classified as different entities, there may be overlap between different diseases in the same patient. Despite EGIDs being relatively novel pathological entities, the research on possible treatments is rapidly growing. In this regard, several randomized controlled trials are currently ongoing to investigate novel molecules, including ad-hoc steroid formulations, immunosuppressants, and mostly monoclonal antibodies that target the specific molecular mediators of EGIDs. This narrative review provides an up-to-date overview of available and investigational drugs for different EGIDs.

Keywords: colitis; dupilumab; eosinophils; esophagitis; gastritis.

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Conflict of interest statement

Giovanni Marasco: Served as an advisory board member for AlfaSigma, EG Pharma, Monteresearch srl, Recordati, and Cineca. Received lecture grants from Agave, AlfaSigma, Bromatech, Clorofilla, Echosens, Ferring, Mayoly Spindler, Menarini, and Schwabe Pharma. Edoardo Vincenzo Savarino has served as a speaker for Abbvie, Agave, AGPharma, Alfasigma, Aurora Pharma, CaDiGroup, Celltrion, Falk, EG Stada Group, Fenix Pharma, Fresenius Kabi, Galapagos, Janssen, JB Pharmaceuticals, Innovamedica/Adacyte, Malesci, Mayoly Biohealth, Omega Pharma, Pfizer, Reckitt Benckiser, Sandoz, SILA, Sofar, Takeda, Tillots, and Unifarco. He has also served as a consultant for Abbvie, Agave, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Diadema Farmaceutici, Falk, Fenix Pharma, Fresenius Kabi, Janssen, JB Pharmaceuticals, Merck & Co., Nestlè, Reckitt Benckiser, Regeneron, Sanofi, SILA, Sofar, Synformulas GmbH, Takeda, and Unifarco. He received research support from Pfizer, Reckitt Benckiser, SILA, Sofar, Unifarco, and Zeta Farmaceutici. Massimo Bellini has served as a speaker for Agave, Aboca, AGPharma, Alfasigma, EG Stada Group, Mayoly Biohealth, Norgine, SILA, Depofarma, SOFAR, Takeda, Diadema, and GE Healthcare. He received research support from Sanofi, Diadema, and Depofarma.

Figures

Figure 1
Figure 1
Proposed algorithm for the diagnosis and treatment of EGIDs.
Figure 2
Figure 2
Mechanisms of action of the most common monoclonal antibodies tested for EGIDs.
See this image and copyright information in PMC

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Supplementary concepts

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