Dilation in EoE: Still Necessary?

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic inflammatory immune-mediated disease characterized by eosinophilic esophageal inflammation, leading to remodeling, fibrosis, and stricture formation. Esophageal dilation is one of the treatment modalities of dysphagia in fibrostenotic EoE, though it does not address the underlying inflammatory process. The development of biological therapies has raised questions about the ongoing need for mechanical dilation.

Summary: Esophageal dilation remains an effective and safe procedure for relieving dysphagia in EoE patients with fibrostenotic changes. New diagnostic modalities like functional lumen imaging probe (FLIP) increase the diagnostic yield of esophageal strictures while evaluating the biomechanical properties of the esophageal wall. Esophageal stricture dilation provides symptoms relief in EoE but has no effect on the inflammation and hence does not prevent disease progression. Recent studies suggest that biological therapies may reverse both the inflammation and the fibrotic remodeling in some patients, potentially reducing the need for dilation. However, in cases of severe fibrosis or narrow-caliber esophagus, dilation remains a cornerstone in the management of EoE.

Key messages: Esophageal dilation is effective for symptomatic improvement in EoE patients with strictures but does not reduce esophageal inflammation. Diagnostic tools like FLIP improve esophageal strictures detection and dilation tailoring. Biologic therapies show promise in targeting esophageal inflammation and fibrosis, but long-term data are needed. Dilation will remain essential for treating the fibrostenotic phenotype of EoE.