Emerging clinical evidence in the treatment of eosinophilic esophagitis

Author(s): CD Parmar , SE Attwood

Primary eosinophilic esophagitis (EoE) is no longer rare. The treatment is currently ad hoc with no licensed medications available. Symptom improvements occur with diet, drugs or esophageal dilatation and these have been applied to patients depending on their age, severity of illness and their need for continuing symptom relief. Problems in treating EoE include difficulties in assessing disease severity and lack of a prognostic markers of disease progression. This article describes the current status of diet and topical steroid therapy. The evidence from randomized trials of biologic agents such as infliximab, mepolizumab, reslizumab and omalizumab show disappointing symptom benefit, despite changes to the immunobiology of the esophageal epithelium. Concerns regarding perforation during dilatation are discussed, and the use of EndoFLIP® to measure esophageal compliance is presented. CRTH-2 antagonists and montelukast are discussed. EoE will continue to require scientific and clinical research until an effective therapy suitable for all is found.