Eosinophilic Esophagitis: All You Need to Know
Eosinophilic esophagitis (EoE) is a relatively new and complex disease first identified approximately 30 years ago. It is characterized by the presence of an elevated eosinophil count, defined as 15 or more eosinophils per high-powered field, in the esophageal tissue. This chronic condition manifests through symptoms such as food impaction, choking, and chest pressure, which can lead to the development of scar tissue over time, significantly impacting a patient’s quality of life.
Current treatment strategies primarily focus on dietary and pharmacological approaches. Dietary management often involves the elimination of specific foods that trigger an allergic or inflammatory response. Inhaled corticosteroids, administered using a swallowing technique, are commonly prescribed to reduce inflammation. These steroids can also be taken in the form of a slush or slurry, designed to coat the esophagus. However, the use of steroids may lead to side effects such as fungal infections in the mouth and throat or hoarseness of voice.
To date, the only FDA-approved medication for EoE is Dupilumab (brand name Dupixent). Dupilumab targets and inhibits interleukin-13 (IL-13) and interleukin-4 (IL-4), key cytokines involved in the inflammatory response, by blocking their shared receptor on B cells. This targeted therapy has shown efficacy in managing symptoms and reducing eosinophilic inflammation in many patients.
A puzzling aspect of EoE is that medications designed to inhibit interleukin-5 (IL-5)—a cytokine responsible for recruiting eosinophils to the esophagus—do not consistently alleviate symptoms such as food impaction or choking. This observation highlights the complex pathophysiology of the disease, suggesting that factors beyond eosinophil recruitment play a role in symptom development and progression.
Research into newer therapies is ongoing, with promising options on the horizon. These include drugs like Tezepelumab, which targets thymic stromal lymphopoietin (TSLP), a key upstream cytokine involved in the inflammatory cascade, and therapies that inhibit Siglec-8, a receptor expressed on eosinophils and mast cells. By targeting these pathways, emerging treatments aim to address the secretory products and broader inflammatory processes associated with EoE, potentially providing more comprehensive symptom relief and disease control.
As our understanding of EoE continues to evolve, the development of more effective treatments will likely focus on addressing the multifaceted immune mechanisms underlying the disease. This progress offers hope for improved management and outcomes for individuals living with this challenging condition.
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