Future of therapy and monitoring for eosinophilic esophagitis and eosinophilic gastrointestinal diseases.

Abstract

Eosinophilic gastrointestinal disorders, including eosinophilic esophagitis, are chronic Th2 mediated diseases. Establishing a diagnosis and initiating treatment is crucial to limit disease progression that may lead to tissue remodeling and the development of strictures that significantly impact patient quality of life. Expert consensus guidelines provide a framework for treating eosinophilic esophagitis with diet elimination, proton pump inhibitors, swallowed topical steroids, or dupilumab and for monitoring with sedated endoscopy for gross and histologic evaluation. While this provides an established algorithm for treating and monitoring eosinophilic esophagitis, there is less established for the rarer eosinophilic gastrointestinal disorders (eosinophilic gastritis, enteritis, and colitis). Research advancements continue to emerge at a rapid pace, identifying potential biomarkers, therapeutic targets, and monitoring strategies. In this article, we review the current accepted methods for treating and monitoring eosinophilic gastrointestinal disorders with a focus on eosinophilic esophagitis, assess what is currently under investigation, and provide an aspirational vision for future disease management with a streamlined algorithm of personalized medicine and less invasive monitoring.