From Past to Present: The Evolution of Pharmacologic Therapies for Eosinophilic Esophagitis

Abstract

Within the evolving landscape of eosinophilic esophagitis (EoE) management are multiple pharmacologic treatment modalities, including proton pump inhibitors (PPIs), swallowed topical corticosteroids, and novel biologic agents. Studies to date on PPIs and corticosteroids have provided valuable insights into how to define the disease, and recently approved biologic therapies are heralding a new era of EoE management. Although progress has been made in treating this complex inflammatory, fibrostenotic disease and in understanding its pathophysiology, several knowledge gaps persist and continue to be investigated. In addition, unknowns exist regarding the long-term safety and efficacy of new EoE treatments and how to position therapies in diverse patient populations. This article aims to provide historical context for the current landscape of pharmacologic treatments in EoE and perspectives on how future development may improve understanding and management of this complex disease.

Keywords: Eosinophilic esophagitis; biologics; pharmacologic treatments; proton pump inhibitors; swallowed topical corticosteroids.

Figure.

Timeline of pharmacologic treatments for EoE from the initial case series descriptions as esophageal eosinophilia with dysphagia (1993) and idiopathic EoE (1994). EMA, European Medicines Agency; EoE, eosinophilic esophagitis; FDA, US Food and Drug Administration; PPI, proton pump inhibitor.