Optimal Assessment, Treatment, and Monitoring of Adults with Eosinophilic Esophagitis: Strategies to Improve Outcomes.

IF 6.2 Q1 IMMUNOLOGY
ImmunoTargets and Therapy Pub Date : 2024-07-24 eCollection Date: 2024-01-01 DOI:10.2147/ITT.S276869
Pierfrancesco Visaggi, Matteo Ghisa, Edoardo Vespa, Alberto Barchi, Amir Mari, Andrea Pasta, Elisa Marabotto, Nicola de Bortoli, Edoardo Vincenzo Savarino
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引用次数: 0

Abstract

Eosinophilic esophagitis (EoE) is a chronic type 2 inflammation-mediated disease characterized by an eosinophil-predominant inflammation of the esophagus and symptoms of esophageal dysfunction. Relevant treatment outcomes in the setting of EoE include the improvement of histology, symptoms, and endoscopy findings, quality of life (QoL), and the psychological burden of the disease. Established validated tools for the assessment of EoE include questionnaires on dysphagia and QoL (ie, DSQ, EEsAI, and EoE-IQ). 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 EoE patients. The EoE endoscopic reference score (EREFS) is the only validated endoscopy score in EoE and can quantify mucosal disease burden. However, esophageal panometry using the functional lumen imaging probe (FLIP) and high-resolution manometry (HRM) have shown potential to optimize the assessment of fibrostenotic features of EoE, providing novel insights into the pathophysiology of symptoms. There is a growing number of licenced and off-label therapeutic options in EoE, with various randomized controlled trials demonstrating the efficacy of proton pump inhibitors, topical steroids, food elimination diets, biological drugs, and esophageal dilatation. However, standardized optimal management strategies of EoE are currently lacking. In this review, we provide an overview of established and novel assessment tools in EoE including patient reported outcomes, FLIP panometry, HRM, endoscopy, and histology outcome measures to improve the outcomes of EoE patients. In addition, we summarize available therapeutic options for EoE based on the most recent evidence.

嗜酸性粒细胞食管炎成人患者的最佳评估、治疗和监测:提高疗效的策略。
嗜酸性粒细胞食管炎(EoE)是一种由 2 型炎症介导的慢性疾病,以食管嗜酸性粒细胞为主的炎症和食管功能障碍症状为特征。食管炎的相关治疗结果包括组织学、症状和内镜检查结果的改善、生活质量(QoL)和疾病的心理负担。用于评估 EoE 的成熟有效工具包括吞咽困难和 QoL 问卷(即 DSQ、EEsAI 和 EoE-IQ)。最近,使用食管过度警觉和焦虑量表(EHAS)评估的食管症状特异性焦虑和过度警觉已成为造成疾病负担的因素,这证实了食管水肿患者心理方面的重要性。食管水肿内镜参考评分(EREFS)是唯一经过验证的食管水肿内镜评分,可以量化粘膜疾病负担。不过,使用功能性管腔成像探头(FLIP)和高分辨率测压法(HRM)进行的食管全景测量已显示出优化咽喉炎纤维狭窄特征评估的潜力,为了解症状的病理生理学提供了新的视角。目前有越来越多的标示外和标示内治疗方法可供选择,各种随机对照试验证明了质子泵抑制剂、局部类固醇、食物排除饮食、生物药物和食管扩张术的疗效。然而,目前尚缺乏标准化的食管水肿最佳治疗策略。在这篇综述中,我们概述了治疗食管水肿的既有和新型评估工具,包括患者报告结果、FLIP 泛影测量、HRM、内镜检查和组织学结果测量,以改善食管水肿患者的治疗效果。此外,我们还根据最新证据总结了治疗咽喉炎的可用方案。
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来源期刊
CiteScore
16.50
自引率
0.00%
发文量
7
审稿时长
16 weeks
期刊介绍: Immuno Targets and Therapy is an international, peer-reviewed open access journal focusing on the immunological basis of diseases, potential targets for immune based therapy and treatment protocols employed to improve patient management. Basic immunology and physiology of the immune system in health, and disease will be also covered.In addition, the journal will focus on the impact of management programs and new therapeutic agents and protocols on patient perspectives such as quality of life, adherence and satisfaction.
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