A recent review highlights a shared approach to managing eosinophilic esophagitis, emphasizing assessment tools, psychological aspects, and treatment options.
The rising incidence of eosinophilic esophagitis (EoE) and the growing options to manage the chronic type 2 inflammation-mediated disease call for a shared approach in clinical practice, according to a review article published in ImmunoTargets and Therapy.
“However, standardized optimal management strategies of EoE are currently lacking,” wrote corresponding author Edoardo Vincenzo Savarino, MD, PhD, and colleagues.
International expert recommendations on monitoring patients with EoE were not published until 2022, and the first clinical guidelines were published just this year. The review summarized various tools and options for assessment and management to further inform physicians on how to care for patients with the complex condition.
Established tools for assessment include patient-reported outcome questionnaires about dysphagia and QOL, such as the Dysphagia Symptoms Questionnaire, the EoE Activity Index, and the EoE Impact Questionnaire. Ad-hoc questionnaires can also be used to better quantify symptom burden and improve the likelihood of a correct diagnosis.
“More recently, esophageal symptom-specific anxiety and hypervigilance, assessed using the esophageal hypervigilance and anxiety scale (EHAS), have emerged as contributors to disease burden, confirming the importance of psychological aspects in patients with EoE,” the authors wrote.
The EoE Endoscopic Reference Score (EREFS) is the only validated endoscopy scoring system that quantifies mucosal disease burden in patients with EoE. In addition, the EREFS has proven useful in evaluating treatment response.
“Several RCTs have reported a significant reduction of EREFS scores in treatment responders compared with non-responders,” the authors noted.
Novel assessment tools include functional luminal imaging probe (FLIP) panometry and high-resolution manometry (HRM). According to the review, both FLIP and HRM show potential for optimizing the assessment of the fibrostenotic features of EoE.
Food elimination diets that identify and avoid trigger foods are a potential first-line treatment, but they require strong patient motivation for adherence.
Regarding medication and dietary treatments, “it must be noted,” the authors wrote, “that EoE is a lifelong disease that rapidly recurs when an effective treatment is withdrawn and that a proportion of patients may lose response during maintenance therapy.”
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