Unmet therapeutic needs in eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a clinicopathologic disease of increasing prevalence in children and adults worldwide. EoE is defined by a robust, acid-resistant, often panesophageal eosinophilia. Disease complications include food impactions and strictures. While much has been learned since it was first described in the late 1970s, there are still a number of unmet clinical needs. This review provides an overview of these and addresses our current state of progress in meeting these challenges. The best diagnostic criteria, the least invasive mechanisms for procuring tissue, the best therapeutic intervention, and an understanding of how therapies affect EoE natural history remain to be systematically addressed. In addition, the classification of EoE subjects by phenotype, genotype, and/or endotype is required but dependent upon further large-scale systematic studies.