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Understanding Eosinophilic Esophagitis: Diagnosis, Management, and the Rising Incidence

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Zara Nwosu
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Understanding Eosinophilic Esophagitis: Diagnosis, Management, and the Rising Incidence

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Eosinophilic esophagitis (EoE) is a chronic inflammatory disease affecting the esophagus, mostly prevalent in individuals with allergies or eczema. Characteristically, this condition presents with difficulty swallowing and is found to be more common in children aged 5-14 years and adults aged 20-45 years. It notably affects males 3-4 times more than females. Recent studies suggest a rising incidence of EoE, although it remains uncertain whether this rise is due to heightened awareness or an actual increase in the disease's prevalence. For effective management of EoE, experts recommend a shared decision-making process between physicians and patients, emphasizing the importance of customized treatment plans based on disease severity and potential risk of future complications.

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Eosinophilic Esophagitis: What is it?

Eosinophilic esophagitis is a clinicopathologic entity characterized by symptoms related to esophageal dysfunction and histologically by eosinophil-rich inflammation limited to the esophagus. The disease is believed to be triggered by food and environmental allergens, leading to an aberrant immune response to antigenic stimulation. Eosinophils, a type of white blood cell, play a significant role in remodeling esophageal tissues, leading to fibrosis through the release of granule cationic proteins and fibrogenic growth factors.

Diagnosis and Management of EoE

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Diagnosis of EoE involves the presence of symptoms, detection of 15 or more eosinophils per high power field on esophageal biopsy, exclusion of other disorders, and high-dose proton pump inhibitor treatment or normal pH monitoring. In terms of management, a European survey indicated significant heterogeneity in practice patterns and suboptimal adherence to EoE guidelines, suggesting a need for improved and consistent clinical practices.

Emerging Therapies

Biological drugs, particularly monoclonal antibodies, are increasingly being considered in the treatment of EoE. These drugs are designed to target the different inflammatory mechanisms involved in EoE pathogenesis. Notably, the European Medicine Agency and US Food and Drug Administration have approved dupilumab for the treatment of EoE. However, further studies are required to assess the long-term effects of such monoclonal antibodies and to identify new potential targets for EoE treatment.

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Challenges in EoE Treatment

Treatment of EoE comes with its own challenges, including the lack of predictive factors for personalized treatment, dietary restrictions, and the need for invasive procedures. Pediatric patients face developmental challenges, impacting crucial stages like oral motor and sensory development. Dr. Mirna Chehade emphasizes the need for a comprehensive approach to EoE management, involving regular office visits assessing diet efficacy, psychological well-being, and quality of life, along with routine screenings for complications.

The Future of EoE Research

There is a critical need for more research to better understand EoE and its management. Recent studies have begun to explore the relationship between environmental and food allergies and PPI response in EoE patients. An increased understanding of these relationships may help to better predict treatment outcomes and personalize therapy. Additionally, ongoing research is shedding light on the psychosocial burden of EoE, emphasizing the importance of considering mental health in the overall management of this chronic condition.

As we continue to learn more about EoE, it is clear that a comprehensive and holistic approach is needed for effective management, involving shared decision-making, a focus on mental health, and ongoing research into new and effective treatments.

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