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Managing eosinophilic esophagitis: challenges and solutions

Authors Shah N, Albert D, Hall N, Moawad F

Received 16 June 2016

Accepted for publication 15 August 2016

Published 16 September 2016 Volume 2016:9 Pages 281—290

DOI https://doi.org/10.2147/CEG.S78428

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Andreas M Kaiser


Nisha A Shah, Dustin M Albert, Noah M Hall, Fouad J Moawad

Department of Medicine, Gastroenterology Service, Walter Reed National Military Medical Center, Bethesda, MD, USA

Abstract: Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated condition defined by symptoms of esophageal dysfunction and dense eosinophilic infiltration of the esophageal mucosa. Therapies consist of anti-eosinophilic medications and specialized diets aimed to decrease the progression of EoE and alleviate its symptoms, namely, dysphagia and food impaction. Assessing response to therapy remains challenging, as treatment end points are not well defined and currently consist of clinical, histologic, and endoscopic features. Newer validated measures may help standardize treatment end points. Emerging data support the use of maintenance therapy, which may reduce disease progression. Optimal dosages, delivery techniques, and duration of treatment need to be determined. When features of fibrostenosis develop, esophageal dilation is a safe and effective adjunctive strategy for improving symptoms. In EoE cases refractory to conventional treatments, newer therapies targeting inflammatory mediators and cytokines are on the horizon.

Keywords: eosinophilic esophagitis, esophagitis, eosinophilia, dysphagia, allergy, corticosteroids, dietary treatment, dilation
 

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