Unmet Needs in Eosinophilic Esophagitis: Do We Still Have Some?

Abstract

Background: Since the late 1990s, eosinophilic esophagitis (EoE) became a known disease characterized by eosinophilic infiltration into the esophagus accompanied by esophageal symptoms. Over the past 2 decades, there has been an exponential increase in the understanding of the epidemiology and pathogenesis of disease leading to new therapies. Despite this, we still have significant knowledge gaps in our clinical care.

Summary: Despite a plethora of knowledge gained about EoE over the last 3 decades, medical care of EoE continues to struggle with uncertainties. Presently, we lack available methods to predict who is at risk of complications or who will be refractory to therapy. There is only a paucity of data about how to maintain long-term control of inflammation, and we have yet to develop clinically applicable biomarkers to predict clinical phenotypes (i.e., those who will recur while on therapy). This review focuses on a few of the common limitations in current care of EoE: (1) diagnosis, (2) accurate food antigen testing, (3) prediction of clinically relevant phenotypes, (4) maintenance and surveillance strategies, (5) optimal disease endpoints, and (6) need for less invasive monitoring.

Key messages: Despite rapid increase in our comprehension of EoE, patients continue to have unmet needs. However, with the continued rapidity of investigation, many of these current deficiencies are being addressed and will likely be resolved in the future.