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Related Experiment Video

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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
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A Practical Update on Pediatric Eosinophilic Esophagitis.

Martina Votto1,2, Maria De Filippo1,2, Silvia Caimmi2

  • 1Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy.

Children (Basel, Switzerland)
|October 28, 2023
PubMed
Summary

Eosinophilic esophagitis (EoE) is a growing allergic condition affecting the esophagus, primarily triggered by food allergens. Current treatments include medication, dietary changes, and endoscopic monitoring, with new biologics emerging.

Keywords:
adolescentsallergychildreneosinophilic esophagitisfood elimination dietproton pump inhibitorquality of lifetopical steroids

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Area of Science:

  • Gastroenterology
  • Allergy and Immunology
  • Pediatrics

Background:

  • Eosinophilic esophagitis (EoE) is an emerging atopic disease of unknown cause, characterized by type 2 inflammation and triggered by food allergens.
  • Impaired esophageal barrier function facilitates inflammatory cell stimulation by food allergens, leading to EoE.
  • Clinical presentations in children and adolescents vary, including feeding issues, vomiting, failure to thrive, pain, dysphagia, and food impaction.

Purpose of the Study:

  • To review the current understanding of EoE pathogenesis, clinical and molecular heterogeneity, and therapeutic approaches.
  • To highlight the importance of achieving deep remission (clinical, endoscopic, histological) and preventing esophageal fibrosis.
  • To discuss the recognition of distinct EoE phenotypes and endotypes and the role of emerging therapies.

Main Methods:

  • Diagnosis and monitoring rely on upper-gastrointestinal endoscopy.
  • Therapeutic strategies include proton pump inhibitors, topical steroids (fluticasone, budesonide), and food elimination diets.
  • Recent advancements involve understanding EoE heterogeneity and evaluating new treatments, including biologics like Dupilumab.

Main Results:

  • Clinical, molecular, endoscopic, and histological features influence EoE evolution and treatment response.
  • Distinct EoE phenotypes and endotypes have been identified, reflecting disease complexity.
  • Dupilumab is the first approved biologic therapy for active EoE in adolescents and adults.

Conclusions:

  • EoE management requires a long-term, multidisciplinary approach with regular follow-ups.
  • Understanding EoE heterogeneity is crucial for personalized treatment strategies.
  • Ongoing research into new therapeutic options, including biologics, is vital for improving patient outcomes.