Eosinophilic esophagitis: indications for treatment

Area of Science:

• Gastroenterology
• Immunology
• Pathology

Background:

• Eosinophilic esophagitis (EoE) treatment goals (symptomatic vs. histological response) remain debated.
• Long-term consequences of untreated EoE symptoms and inflammation lack comprehensive data.
• Active EoE presents significant challenges impacting patient well-being and esophageal health.

Purpose of the Study:

• To review established indications for treating active eosinophilic esophagitis.
• To highlight the benefits of treating EoE based on current evidence.
• To underscore the importance of managing EoE to prevent complications.

Main Methods:

• Literature review of clinical studies and animal models concerning EoE treatment.
• Analysis of the impact of untreated EoE on patient quality of life.
• Evaluation of risks associated with active eosinophilic inflammation.

Main Results:

• Dysphagia in EoE significantly impairs daily life, with treatment enhancing quality of life.
• Untreated EoE increases the risk of prolonged and potentially dangerous food impactions.
• Chronic eosinophilic inflammation can lead to esophageal remodeling, causing wall thickening, stiffness, and strictures.
• Emerging evidence suggests untreated EoE may be a risk factor for severe herpes simplex virus (HSV) esophagitis.

Conclusions:

• There are compelling reasons to treat clinically and histologically active EoE.
• Treatment can alleviate dysphagia, prevent food impactions, and mitigate esophageal remodeling.
• Managing EoE may also reduce the risk of secondary infections like HSV esophagitis, supporting a proactive treatment approach.