Editorial: Targeting the Future of Eosinophilic Oesophagitis Management DOI Open Access
Luisa Bertin, Edoardo Savarino

Alimentary Pharmacology & Therapeutics, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 16, 2024

Eosinophilic oesophagitis (EoE) is a chronic, immune/antigen-mediated condition characterised by eosinophil-dominated inflammation of the oesophagus, leading to dysphagia and oesophageal dysfunction [1]. Despite advancements in diagnosis treatment, EoE management remains challenging due its chronicity high relapse rates after treatment discontinuation [2]. Recent innovations, including novel drug delivery systems biologic therapies, offer new avenues for improving patient outcomes. The Phase II randomised clinical trial (RCT) ESO-101, mucoadhesive system mometasone furoate, represents pivotal step towards precision medicine [3]. This approach allows localised mucosa, minimising systemic side effects. study demonstrated significant histologic endoscopic improvements with ESO-101. Peak eosinophil counts decreased 49.1 per high-power field on ESO-101 compared 6.6 increase placebo (p = 0.0318). Additionally, appearance as defined Esophagitis Endoscopic Reference Score (EREFS) improved, median decrease from 7 4 group, while group showed no change 0.001). However, relief odynophagia was comparable both groups, underscoring complex nature and, probably, difficulties assessing outcome according current methods [4]. discordance between histological outcomes observed aligns findings other RCTs investigating lirentelimab, benralizumab, mepolizumab reslizumab, where positive reached despite symptom persistence. these complexities, regulatory authorities continue mandate reduction co-primary endpoint registration trials [5]. Moreover, discrepancies highlight that perception influenced not only eosinophilic but also structural remodelling, adaptive behaviours psychological factors, such hypervigilance anxiety [6, 7]. prior dilation procedures can affect trajectories during therapy, introducing variability [8]. Furthermore, eosinophils are key diagnostic therapeutic markers, they part larger inflammatory cascade includes Th2 cells, mast cytokines mediators could contribute These observations importance addressing physiological aspects disease. expanding landscape proton pump inhibitors, elimination diets, topical corticosteroids like dupilumab, offering diverse pathways remission [9, 10]. several questions remain. Should goal always be complete remission, or partial acceptable if it results durable control? How support effectively integrated into disease management? Advances biomarkers, motility assessments imaging technologies promise refine goals enable more personalised care strategies. exemplifies progress being made emphasising need deeper understanding pathophysiology. Variability responses highlights approaches, supported collaboration among researchers, clinicians patients within multidisciplinary framework. Moving forward, must extend beyond controlling restoring quality life individuals through combination medical innovation patient-centred care. Luisa Bertin: conceptualization, writing – review editing, original draft. Edoardo Vincenzo Savarino: supervision, article linked Lucendo et al paper. To view this article, visit https://doi.org/10.1111/apt.18443. Data sharing applicable data were created analyzed study.

Language: Английский

The Esophageal Mucosa DOI
Pierfrancesco Visaggi, Evan S. Dellon

Gastrointestinal Endoscopy Clinics of North America, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 1, 2025

Language: Английский

Citations

0
The Dynamic Evolution of Eosinophilic Esophagitis DOI Creative Commons

Amir Farah,

Tarek Assaf,

Jawad Hindy

et al.

Diagnostics, Journal Year: 2025, Volume and Issue: 15(3), P. 240 - 240

Published: Jan. 21, 2025

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory condition of the esophagus characterized by eosinophilic infiltration, and hallmark symptoms esophageal dysfunction such as dysphagia food impaction. Over past three decades, EoE has been recognized distinct clinical entity, distinguished from gastroesophageal reflux disease (GERD) through advancements in diagnostic techniques, particularly endoscopy with biopsy. The rising global prevalence reflects enhanced awareness, evolving criteria, environmental along lifestyle changes. etiology multifactorial, involving genetic predispositions, immune dysregulation, gut microbiome, triggers, including dietary allergens aeroallergens. Key mechanisms include type 2 helper T-cell (Th2)-driven response, epithelial barrier dysfunction, variants CAPN14 TSLP. Chronic inflammation leads to tissue remodeling, fibrosis, narrowing, contributing progression complications. Management strategies have evolved elimination, proton pump inhibitors, topical corticosteroids, biologics, endoscopic interventions for fibrostenotic Emerging therapies targeting cytokines interleukin (IL)-4, IL-5, IL-13, alongside novel tools like string test Cytosponge, offer promising avenues improved control non-invasive monitoring. Long-term surveillance combining histological evaluations biomarkers critical optimizing outcomes preventing Future research should address gaps understanding role refine therapeutic approaches, develop personalized improve management patient quality life.

Language: Английский

Citations

0
Editorial: Targeting the Future of Eosinophilic Oesophagitis Management DOI Open Access
Luisa Bertin, Edoardo Savarino

Alimentary Pharmacology & Therapeutics, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 16, 2024

Eosinophilic oesophagitis (EoE) is a chronic, immune/antigen-mediated condition characterised by eosinophil-dominated inflammation of the oesophagus, leading to dysphagia and oesophageal dysfunction [1]. Despite advancements in diagnosis treatment, EoE management remains challenging due its chronicity high relapse rates after treatment discontinuation [2]. Recent innovations, including novel drug delivery systems biologic therapies, offer new avenues for improving patient outcomes. The Phase II randomised clinical trial (RCT) ESO-101, mucoadhesive system mometasone furoate, represents pivotal step towards precision medicine [3]. This approach allows localised mucosa, minimising systemic side effects. study demonstrated significant histologic endoscopic improvements with ESO-101. Peak eosinophil counts decreased 49.1 per high-power field on ESO-101 compared 6.6 increase placebo (p = 0.0318). Additionally, appearance as defined Esophagitis Endoscopic Reference Score (EREFS) improved, median decrease from 7 4 group, while group showed no change 0.001). However, relief odynophagia was comparable both groups, underscoring complex nature and, probably, difficulties assessing outcome according current methods [4]. discordance between histological outcomes observed aligns findings other RCTs investigating lirentelimab, benralizumab, mepolizumab reslizumab, where positive reached despite symptom persistence. these complexities, regulatory authorities continue mandate reduction co-primary endpoint registration trials [5]. Moreover, discrepancies highlight that perception influenced not only eosinophilic but also structural remodelling, adaptive behaviours psychological factors, such hypervigilance anxiety [6, 7]. prior dilation procedures can affect trajectories during therapy, introducing variability [8]. Furthermore, eosinophils are key diagnostic therapeutic markers, they part larger inflammatory cascade includes Th2 cells, mast cytokines mediators could contribute These observations importance addressing physiological aspects disease. expanding landscape proton pump inhibitors, elimination diets, topical corticosteroids like dupilumab, offering diverse pathways remission [9, 10]. several questions remain. Should goal always be complete remission, or partial acceptable if it results durable control? How support effectively integrated into disease management? Advances biomarkers, motility assessments imaging technologies promise refine goals enable more personalised care strategies. exemplifies progress being made emphasising need deeper understanding pathophysiology. Variability responses highlights approaches, supported collaboration among researchers, clinicians patients within multidisciplinary framework. Moving forward, must extend beyond controlling restoring quality life individuals through combination medical innovation patient-centred care. Luisa Bertin: conceptualization, writing – review editing, original draft. Edoardo Vincenzo Savarino: supervision, article linked Lucendo et al paper. To view this article, visit https://doi.org/10.1111/apt.18443. Data sharing applicable data were created analyzed study.

Language: Английский

Citations

0