Treatment of eosinophilic esophagitis: literature review and own clinical observations

Russian Journal of Allergy, Год журнала: 2025, Номер unknown

Опубликована: Март 6, 2025

Aim: to systemize existing data on the treatment strategies for patients with eosinophilic esophagitis. Eosinophilic esophagitis is a T2- disease characterized by infiltration of esophageal mucosa, subepithelial and submucosal fibrosis, progressive dysphagia. Early diagnosis appropriate can prevent development strictures other complications. The includes use elimination diets, pharmacological therapy, endoscopic dilation or bougienage strictures. most effective drugs achieving clinical histological remission in are proton pump inhibitors, topical glucocorticosteroids, biological agents represented monoclonal antibodies. Over time, advantages systemic antibody therapies (anti-IL4/IL-13) over inhibitors glucocorticosteroids have become evident, particularly terms their impact mucosal inflammation remodeling wall. Currently, only approved anti-interleukin drug dupilumab, which has demonstrated high efficacy safety trials children aged 1 year older, as well adults. Endoscopic performed who stenosis (with an diameter 13 mm) following course pharmacotherapy. To this day, numerous questions remain regarding maintenance its duration, predictors progression. With emergence new biologic esophagitis, accessibility, long-term efficacy, critically important considerations.

Язык: Английский

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Frequent report of vitamin deficiencies and use of supplements and complementary/alternative treatment approaches in patients with eosinophilic gastrointestinal diseases

Therapeutic Advances in Rare Disease, Год журнала: 2025, Номер 6

Опубликована: Март 1, 2025

Background: Eosinophilic gastrointestinal diseases (EGIDs) impact nutrition. Objectives: To assess the frequency of vitamin deficiencies, supplement use, and complementary/alternative-medication (CAM) use in EoE non-EoE EGID patients. Design: Cross-sectional study. Methods: We surveyed members Partners ( egidpartners.org ), a patient-centered research network, to physician-diagnosed CAM patients with versus EGIDs. Results: Of 81 (58 23 EGID), self-reported deficiencies were higher EGIDs compared (61% vs 50%; p = 0.38; Table 1). Most (77%) indicated taking vitamins or supplements, cases (87% 72%; 0.16). Use >30 different supplements was reported. For CAM, herbal approaches more frequent (26% 5%; 0.008). Conclusion: Vitamin supplement/CAM are EGIDs, highlighting need for additional treatment.

Язык: Английский

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Eosinophilic esophagitis: Prevalence, diagnosis, and treatment in childhood and adulthood

Deutsches Ärzteblatt international, Год журнала: 2025, Номер unknown

Опубликована: Март 27, 2025

Eosinophilic esophagitis is a chronic, Th2 immune-mediated disease of the esophagus characterized by esophageal dysfunction and predominant eosinophilic inflammation. Its prevalence incidence have risen in recent years now stand at 16.1 per 100 000 persons 1.7 year. This review based on selected publications retrieved search PubMed, Medline, Google Scholar for clinical trials, reviews, guidelines that were published between 2011 2024 either English or German (search term, "eosinophilic esophagitis"). markedly impairs patients' quality life; its diagnosis often delayed. It can be treated with an appropriately altered diet, pharmacotherapy, and/or endoscopic intervention ("diet, drugs, dilatation"). Elimination diets omission 2, 4, 6 food groups lead to histological remission 43%, 60%, 79% patients, respectively. An entirely amino acid-based diet leads over 90% but only performed limited time. Topical corticosteroids 60-87% cases, proton-pump inhibitors 30-50%, dupilumab (anti-IL-4Rα/IL-13Rα1) 60-86%. These treatments differ widely their side-effect profiles restrictions they impose everyday life, use must considered individually each patient. Because chronic disease, maintenance therapy needed long term. was first described three decades ago. Effective are available, questions remain concerning long-term course therapy, non-invasive markers activity, among others. Delays should avoided. The appropriate treatment care affected patients assure them optimal life.

Язык: Английский

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Circulating Food Allergen‐Specific Antibodies, Beyond IgG4, Are Elevated in Eosinophilic Esophagitis

Clinical & Experimental Allergy, Год журнала: 2025, Номер unknown

Опубликована: Апрель 14, 2025

ABSTRACT Introduction Eosinophilic esophagitis (EoE) is a chronic inflammatory condition with an incompletely understood immuno‐pathogenesis involving T2 response. EoE triggered by food allergens although, unlike IgE‐mediated allergies, it exhibits high IgG4 levels in oesophageal biopsies and circulation. We investigated whether other antibody isotypes specific for are elevated vary disease activity. Methods Plasma samples from patients active ( n = 51), inactive 82) non‐EoE controls 14) were analysed food‐specific IgG IgA subclasses against casein, whey, wheat, egg individual cow's milk ELISA. α‐lactalbumin (Bos d 4)‐ β‐lactoglobulin 5)‐specific B cells measured flow cytometry subset of patients. Results Food allergen‐specific antibodies the plasma varied across subgroups controls. Elevated confirmed strong response to allergens, including wheat egg. α S1 ‐casein 9)‐specific IgG, IgG2, IgG4, IgA1 IgA2 differed between EoE. β‐casein 11, A1 variant) measurements showed higher IgG2 both groups, whereas whey‐derived opposing responses: Bos 4 responses favoured 5 multiple Allergen‐specific could not be isolated Conclusion Our findings reveal distinct profiles plasma, beyond highlighting complex immune allergens. Differential support their clinical relevance dietary management strategies, while absence circulation likely restricts production inflamed oesophagus. Future research should explore these can guide personalised treatment novel therapeutic targets

Язык: Английский

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Dupilumab in adolescent eosinophilic esophagitis: Experience with fibrostenosis and eosinophilic gastrointestinal disease with esophageal involvement

Journal of Pediatric Gastroenterology and Nutrition, Год журнала: 2024, Номер 78(6), С. 1337 - 1341

Опубликована: Апрель 8, 2024

Abstract We evaluated patients aged 12–20 on dupilumab 300 mg weekly for treatment of eosinophilic esophagitis (EoE) who had ≥1 follow‐up endoscopy at a tertiary care pediatric hospital ( n = 18). Fifty percent inflammatory EoE 9), 22% fibrostenotic 4), and 28% non‐EoE gastrointestinal disease (EGID) with esophageal involvement 5). Ninety‐four discontinued topical corticosteroids (TCS) 2–4 weeks after starting dupilumab. Eighty‐nine histological response (<15 eosinophils/high‐powered field) an average 19.1 weeks. One hundred exhibited 16.8 Of EGID, 60% achieved 40.1 In small cohort, was very effective adolescent despite rapid weaning TCS. Dupilumab also somewhat EGID involvement; however, longer duration therapy required.

Язык: Английский

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Dupilumab Improves Health-Related Quality of Life and a Range of Symptoms in Patients With Eosinophilic Esophagitis

The American Journal of Gastroenterology, Год журнала: 2024, Номер unknown

Опубликована: Июнь 28, 2024

INTRODUCTION: Improvements in symptomatic experience and health-related quality of life (HRQoL) are among the most important treatment benefits patients with eosinophilic esophagitis (EoE). We assessed impact dupilumab on HRQoL, patients' impression dysphagia, symptoms beyond dysphagia adults/adolescents (≥12 years) EoE parts A B LIBERTY TREET (NCT03633617) study. METHODS: The Symptom Questionnaire (EoE-SQ; frequency severity nondysphagia symptoms), Impact (impact HRQoL), Patient Global Impression Severity Change were used to assess efficacy weekly 300 mg vs placebo. RESULTS: At week 24, reduced EoE-SQ Frequency (least squares mean difference placebo [95% confidence interval] part −1.7 [–2.9, −0.5], −1.4 [–2.3, −0.5]; both P < 0.01) (part −2.0 [–3.9, 0.0], 0.05, −1.5 [–3.0, 0.1], = 0.07) overall scores, improved scores across all individual items. Improvement group was clinically meaningful patients. Dupilumab also meaningfully average item at particularly emotional sleep disturbance. More dupilumab-treated reported improvement or having no per 24. DISCUSSION: multiple aspects EoE.

Язык: Английский

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Advances and Ongoing Challenges in Eosinophilic Gastrointestinal Disorders presented at the CEGIR/TIGERS Symposium at the 2024 American Academy of Allergy, Asthma, & Immunology Meeting

Journal of Allergy and Clinical Immunology, Год журнала: 2024, Номер 154(4), С. 882 - 892

Опубликована: Авг. 5, 2024

Язык: Английский

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Dupilumab improves clinical and histologic features of eosinophilic esophagitis prior to 12 weeks of treatment

Clinical and Translational Allergy, Год журнала: 2024, Номер 14(1)

Опубликована: Янв. 1, 2024

Dupilumab is a human monoclonal antibody against interleukin-4 receptor alpha subunit. an approved treatment for inducing remission of eosinophilic esophagitis (EoE).1 EoE histologic with dupilumab has only been demonstrated in patients after at least 12 weeks treatment.2-6 Current guidelines recommend waiting re-evaluation until 20–24 dupilumab.1 It unknown if increasing length improves its efficacy. Because requires invasive biopsies, and important to prevent progressive esophageal damage, research investigating the effects on prior warranted. We conducted retrospective study single medical clinic. The electronic record was searched between 2017 2023 using International Classifications Disease, 10th revision code K20.0 esophagitis. excluded who had (1) never started dupilumab; (2) no confirmation defined by ≥ 15 eos/hpf; or (3) while dupilumab. Histologic evaluation assessed 2 biopsies each proximal, middle, distal esophagus. Endpoints were peak eosinophil counts (eosinophils per high-power field; eos/hpf), endoscopic reference scores (EREFS), composite symptom score which (dysphagia, food impaction/choking, regurgitation/vomiting, heartburn/chest pain, abdominal pain) graded (0 = absent, 1 mild, moderate, 3 severe) summed. This deemed exempt from institutional review board approval WCG IRB. From record, 658 identified, 534 initiated dupilumab, 6 did not have EoE, 39 repeat initiation. Therefore, 79 included this study. median age 27.6 years (Q1 Q3, 21.8–36.1), 48 (60.8%) male, (15.2%) pediatric (Table 1). Sixty (75.9%) atopic comorbidity, including allergic rhinitis (43 patients, 54.4%), asthma (27 34.2%), dermatitis (13 16.5%), allergies (30 38.0%). Patients 22.7 16–26.7). Dosages 300 mg every week (71 89.9%), other loading dose 600 (7 8.9%), 200 400 (1 patient, 1.3%). Of 0–12 weeks. 5.5 4–6), significantly decreased 0 0–1; Wilcoxon matched-pairs signed rank test, p 0.000488) Median 44.5 eos/hpf 32.5–53.5) baseline 0–15.5; 0.000977) Endoscopic available (19%) our cohort. In weeks, EREFS decrease (median, 2; Q1 1–4) versus 0; 0–1.5; 0.25). However, change also insignificant 12–24 (p 0.13), greater than 24 0.25), suggesting insignificance may be due low n. induce clinical benefit treatment. There significant differences changes 0.1350), count 0.0746); 0.8771) 12, 12–24, terms response, 9 (75%) histologically responsive group, 28 (73.7%) 26 (89.7%) longer group. difference proportion response groups (Fisher's exact 0.2569). Subanalysis 7 >1 evaluations summarized Figure 1. Three unresponsive early timepoints (Patient 4 Patient 5 weeks) without addition combination therapy. contrast, remained over therapy omeprazole mometasone, respectively. their Our subanalysis suggests that certain are EGDs respond later timepoints. Further needed predict EGDs. Swimmer plot multiple * indicates mometasone 1.6 twice daily. ** 20 once *** mg, as opposed week. conclusion, induced before treatment, there clinical, histologic, 2–24 beneficial identify earlier previous indicate.1 should investigate appropriate window performed. Twan Sia: Conceptualization (equal); data curation formal analysis investigation methodology validation visualization writing—original draft writing—review editing (equal). Amanda Miller: Data Leeon Bacchus: Jennie Young: Aditya P. Narayan: Rachel Solecki: Investigation Jerry Fu: Yuting Jiang: Raisa Khuda: Stanley Liu: Kathleen Love: Shibani Mallik: Amina Sara Matmatte: Paige McDonald: Tanvi Telukunta: Alyssa Roby: Saad Shami: Michelle Zheng: Madison Headen: John Leung: project administration resources supervision None. consultant Devine; Millimet Branch Professional Education; Sanofi; Huron Consulting Services LLC; Takeda; Ribon Therapeutics; Tegus; Slingshot; Guidepoint; Cowen; AstraZeneca; Regeneron; AbbVie. None authors relevant conflicts interests disclose. received specific grant any funding agency public, commercial, not-for-profit sectors. All de-identified materials stored HIPPA-compliant, password-protected, cloud-based storage. Access these files will provided upon reasonable request corresponding author, Leung.

Язык: Английский

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Esophageal remodeling in eosinophilic esophagitis

Current Opinion in Gastroenterology, Год журнала: 2024, Номер 40(4), С. 291 - 298

Опубликована: Апрель 12, 2024

Eosinophilic esophagitis (EoE) is a Th2 immune/antigen-mediated disorder characterized by esophageal dysfunction and eosinophilic inflammation. Worsening dysphagia food impactions are significant complications associated with remodeling fibrostenotic disease. This review highlights the most recent research findings pertaining to mechanisms of sub-epithelial fibrosis in EoE, current diagnostic tools, therapeutic approaches.

Язык: Английский

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Crafting a Therapeutic Pyramid for Eosinophilic Esophagitis in the Age of Biologics

Clinical Gastroenterology and Hepatology, Год журнала: 2024, Номер 22(9), С. 1763 - 1769

Опубликована: Сен. 1, 2024

Язык: Английский

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