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

Alimentary Pharmacology & Therapeutics, Год журнала: 2024, Номер unknown

Опубликована: Дек. 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.

Язык: Английский

Eosinophilic Esophagitis and Cow’s Milk: Mechanisms, Challenges, and Treatment Perspectives DOI Open Access
Giulio Dinardo, Alessandro Fiocchi, Maria Cristina Artesani

и другие.

Nutrients, Год журнала: 2025, Номер 17(2), С. 265 - 265

Опубликована: Янв. 12, 2025

Eosinophilic esophagitis is a chronic, antigen-driven, immune-mediated disease characterized by esophageal dysfunction and significant eosinophilic infiltration. Its rising incidence prevalence over recent decades reflect both increased clinical awareness the influence of environmental factors such as dietary patterns allergen exposure. Among food allergens, cow’s milk proteins are most commonly implicated triggers, contributing to inflammation through complex immunological pathways involving IgE-mediated non-IgE-mediated mechanisms. Dietary elimination has been shown induce histologic remission in 60% pediatric patients, underscoring its pivotal role management. Despite these promising results, challenges persist, including variability individual responses, burden adherence restrictive diets, gaps understanding molecular mechanisms driving milk-induced inflammation. This review examines relationship between milk, focusing on pathogenesis management, offering insights into therapeutic implications. Understanding interplay particularly may inform development targeted interventions improve outcomes for affected patients.

Язык: Английский

Процитировано

1
Dupilumab is efficacious for eosinophilic esophagitis irrespective of prior swallowed budesonide or fluticasone, or prior treatments used alongside swallowed topical corticosteroids: results from the phase 3, randomized, placebo-controlled, LIBERTY EoE TREET trial DOI Creative Commons
Albert J. Bredenoord, Evan S. Dellon, Christoph Schlag

и другие.

Expert Review of Gastroenterology & Hepatology, Год журнала: 2025, Номер unknown, С. 1 - 13

Опубликована: Фев. 5, 2025

Background Standard treatments for eosinophilic esophagitis (EoE) may present adherence, tolerance, and efficacy challenges. Dupilumab 300 mg weekly is approved the treatment of EoE in patients ≥ 1 year old, weighing 15 kg. This analysis aimed to evaluate dupilumab from LIBERTY TREET trial (NCT03633617), with prior history different interventions.

Язык: Английский

Процитировано

0
Outcomes in eosinophilic esophagitis: current understanding and future directions DOI
Sara Urbani, Giulio Dinardo, Maria Cristina Artesani

и другие.

Current Opinion in Allergy and Clinical Immunology, Год журнала: 2025, Номер unknown

Опубликована: Апрель 8, 2025

Purpose of review Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder that demands lifelong management due to its potential progress fibrosis and esophageal strictures. This synthesizes current strategies for evaluating EoE outcomes highlights emerging approaches aimed at reconciling the often discordant relationship between clinical symptoms histologic findings. An updated synthesis crucial guide evolving practices. Recent findings literature emphasizes multifaceted nature EoE, revealing limitations in traditional outcome measures. Advances patient-reported (PROs), scoring systems, endoscopic assessments have enriched our understanding disease activity. Furthermore, integration functional through modalities such as high-resolution manometry EndoFLIP, along with digital data integration, has refined monitoring provided nuanced insights into treatment responses long-term progression. Additionally, evidence suggests integrating novel biomarkers may further refine stratification outcomes. Summary A multidimensional approach combines clinical, histologic, endoscopic, personalized EoE. These pave way improved therapeutic decision-making highlight need standardized, comprehensive tools both practice future research. additional advocate shift towards precision medicine, emphasizing multidisciplinary patient-centric approaches.

Язык: Английский

Процитировано

0
Sex‐related differences in the presentation, management and response to treatment of eosinophilic esophagitis: Cross sectional analysis of EoE CONNECT registry DOI Creative Commons
Emilio J. Laserna‐Mendieta, Sergio Casabona, Edurne Amorena

и другие.

United European Gastroenterology Journal, Год журнала: 2024, Номер unknown

Опубликована: Ноя. 8, 2024

Eosinophilic esophagitis (EoE) predominantly affects males across all ages; however, little is known about sex differences for other aspects of EoE.

Язык: Английский

Процитировано

1
Understanding tissue injury and remodelling in eosinophilic oesophagitis: development towards personalised medicine DOI
Giovanni Santacroce, Carlo Maria Rossi, Marco Vincenzo Lenti

и другие.

Gut, Год журнала: 2024, Номер unknown, С. gutjnl - 333994

Опубликована: Дек. 10, 2024

Eosinophilic oesophagitis (EoE) is a chronic, immune-mediated condition characterised by eosinophilic infiltration of the oesophagus, leading to significant morbidity due oesophageal dysfunction. The pathogenic course EoE begins with tissue injury, marked intricate interplay barrier dysfunction and T helper 2-mediated inflammation. In response damage, subsequent phase remodelling features complex interaction between epithelial cells stromal cells, aimed at repair. persistence inflammation drives these mechanisms towards fibrostenosis, mainly through transforming growth factor-dependent, myofibroblast-driven accumulation extracellular matrix. Currently, treatment options for are limited, dietary intervention, proton pump inhibitors oral steroids serving as first-line therapies. Dupilumab, an antiinterleukin (IL) 4/IL-13 agent, only biologic that has been approved European American regulatory authorities. However, emerging OMIC technologies significantly advance our understanding pathogenesis, revealing novel cellular molecular driving disease. This progress accelerated identification new therapeutic targets agents, some already under clinical investigation, potentially expanding arsenal paving way more personalised approaches. this evolving landscape, artificial intelligence (AI) shown great potential further elaborate on complexities heterogeneity, offering standardised tools diagnosis, disease phenotyping, prediction response. Though still in their early stages, integrating OMICs AI marks pivotal step precision medicine EoE.

Язык: Английский

Процитировано

1
Editorial: Targeting the Future of Eosinophilic Oesophagitis Management DOI Open Access
Luisa Bertin, Edoardo Savarino

Alimentary Pharmacology & Therapeutics, Год журнала: 2024, Номер unknown

Опубликована: Дек. 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.

Язык: Английский

Процитировано

0