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Background: First-line treatment of eosinophilic esophagitis (EoE) includes monotherapy with proton-pump inhibitors (PPIs), food elimination diet (FED), or topical corticosteroids. Current guidelines suggest patients with EoE should continue any responsive first-line monotherapies. However, the efficacy of FED monotherapy in patients with EoE responsive to PPI monotherapy has not been well studied. Our study aimed to investigate how attempting FED monotherapy after experiencing remission of EoE after PPI monotherapy influenced long-term EoE management., Methods: We retrospectively identified patients with EoE responsive to PPI monotherapy who trialed FED monotherapy. We then employed a mixed method approach to a prospective cohort. Selected patients were observed long term for quantitative outcomes, while qualitative results were obtained from patient surveys regarding their perspectives on the trial of FED monotherapy., Results: We identified 22 patients who trialed FED monotherapy after experiencing remission of EoE following PPI monotherapy. Of these 22 patients, 13 had remission of EoE with FED monotherapy, while 9 had re-activation of EoE. Out of 22 patients, 15 were enrolled in a cohort for observation. No exacerbations of EoE occurred while on maintenance treatment. Most patients stated that they would recommend this process to others with EoE (93.33%) and that trial of FED monotherapy helped them identify a treatment plan that aligned with their lifestyle (80%)., Conclusion: Our work shows that FED monotherapy can be an effective alternative for patients with EoE responsive to PPI monotherapy that may improve patient quality of life, suggesting alternative treatment options should be considered for monotherapy-responsive EoE., (© 2023. The Author(s).)

Eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus, has been increasing in incidence over the past several years. Mainstays of treatment include dietary modifications, steroids, proton pump inhibitors (PPIs), and endoscopic dilation, with the goal being to control disease progression, promote remission, and alleviate symptoms, such as dysphagia and food impaction. In addition to these well-known treatment options, preliminary studies on new medications that target specific inflammatory mediators involved in the pathogenesis of EoE have shown promise in improving symptoms. This review article summarizes and discusses the application and efficacy of long-standing and promising new treatment options for EoE.

Résumé: Autrefois considérée comme une maladie rare, l'œsophagite à éosinophiles (EoE) suscite depuis une vingtaine d'années un intérêt croissant et est devenue l'une des affections les plus couramment diagnostiquées au cours de l'endoscopie digestive haute pour dysphagie chez l'enfant et l'adulte. La physiopathologie de cette affection est complexe et regroupe plusieurs mécanismes, notamment une réponse immunitaire anormale vis-à-vis d'antigènes environnementaux, une altération et fibrose de la muqueuse œsophagienne. Le diagnostic d'EoE est à la fois clinique avec dysfonction œsophagienne et histologique avec une infiltration de la muqueuse œsophagienne par les polynucléaires éosinophiles. L'arsenal thérapeutique pour traiter cette maladie est relativement large : règles hygiéno-diététiques, traitements pharmacologiques tels que les inhibiteurs de la pompe à protons et corticoïdes topiques, mais aussi les anticorps monoclonaux, en cours d'étude. L'endoscopie occupe également une place de choix dans la prise en charge thérapeutique avec une innocuité bien établie, notamment dans les formes fibro-sténosantes où l'efficacité des traitements pharmacologiques est souvent mise en défaut. Enfin, l'endoscopie a également un intérêt dans le suivi de la maladie avec un score de référence endoscopique « EREFS » (pour Exsudats, Anneaux, Œdèmes, Sillons et Sténoses) utilisé comme outil standardisé pour mieux évaluer et surveiller la maladie. Nous nous intéresserons ici particulièrement au rôle de l'endoscopie dans le diagnostic, le traitement et le suivi de l'EoE. Previously considered as a rare disease, eosinophilic esophagitis (EoE) has aroused growing interest over the past twenty years and has become one of the most currently diagnosed disease during upper digestive endoscopy in the context of dysphagia in children and adults. The pathophysiology of esophagitis is complex and involves several mechanisms, including, an abnormal immune response to environmental antigens, alteration of the esophageal mucosa, and the development of fibrosis. The diagnosis of EoE is both clinical with esophageal dysfunction and histological with infiltration of the esophageal mucosa by eosinophilic polynuclei. The therapeutic arsenal to treat this pathology is relatively broad and calls upon hygienic-dietary rules, pharmacological treatments such as proton pump inhibitors and topical corticoids, and also monoclonal antibodies currently under studies. Endoscopy also occupies an important role in therapeutic management, particularly in fibro-stenosing forms of EoE where the efficacy of pharmacological treatments is often challenged, with well-established safety. Finally, endoscopy also has an interest in the follow-up of the disease with an endoscopic reference score which is EREFS (exudates, rings, oedemas, furrows and stenoses) used as a standardized tool to better evaluate and monitor EoE. Here we will focus on the role of endoscopy in the diagnosis, treatment and follow-up of EoE. [ABSTRACT FROM AUTHOR]

Over the past decade, the role of proton pump inhibitor (PPI) medication has evolved from a diagnostic tool for Eosinophilic Esophagitis (EoE), by excluding patients with PPI responsive esophageal eosinophilia (PPI-REE), to a therapy for EoE. This transition resulted from the Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the Appraisal of Guidelines for Research and Evaluation II (AGREE) Conference to support PPI therapy for EoE in children and adults. Additional recent advances have suggested a role for genetic variations that might impact response to PPI therapy for EoE. This review article will explore a brief background of EoE, the evolution of PPI therapy for EoE and its proposed mechanisms, efficacy and safety in children and adults, and considerations for future PPI precision medicine in patients with EoE. [ABSTRACT FROM AUTHOR]

Eosinophilic esophagitis is a relatively recently discovered disease of increasing incidence and prevalence and is a common cause of dysphagia and food bolus impaction. The definition of eosinophilic esophagitis continues to evolve, most recently with the characterization of proton pump inhibitor-responsive esophageal eosinophilia. The number of high-quality prospective, controlled trials guiding therapeutic decisions in eosinophilic esophagitis has increased steadily over the past several years. Treatment options at present focus on dietary therapy, particularly implementation of a 6-food elimination diet, and medical therapy, primarily the use of swallowed, topical corticosteroids. Proton pump inhibitors play an important role in current management. Conservative esophageal dilation is effective at ameliorating dysphagia in symptomatic patients with esophageal strictures. We conducted an evidence-based review of the diagnosis and treatment options in adults with eosinophilic esophagitis. The understanding of eosinophilic esophagitis continues to be refined. Continued validation of appropriate endpoints, however, is essential to establish the efficacy of existing and novel therapeutic approaches. [ABSTRACT FROM AUTHOR]