Diagnosis, management and therapeutic options for eosinophilic esophagitis.

Autor:	Caminati M; Asthma Center and Allergy Unit, Center for Hyper-eosinophilic dysimmune conditions, Integrated University Hospital of Verona.; Department of Medicine, University of Verona, Verona., Senna G; Asthma Center and Allergy Unit, Center for Hyper-eosinophilic dysimmune conditions, Integrated University Hospital of Verona.; Department of Medicine, University of Verona, Verona., Maule M; Asthma Center and Allergy Unit, Center for Hyper-eosinophilic dysimmune conditions, Integrated University Hospital of Verona.; Department of Medicine, University of Verona, Verona., Di Sabatino A; Department of Medicine and Medical Therapeutics, University of Pavia.; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy., Rossi CM; Department of Medicine and Medical Therapeutics, University of Pavia.; Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Jazyk:	angličtina
Zdroj:	Current opinion in allergy and clinical immunology [Curr Opin Allergy Clin Immunol] 2024 Jun 01; Vol. 24 (3), pp. 122-128. Date of Electronic Publication: 2024 Apr 25.
DOI:	10.1097/ACI.0000000000000982
Abstrakt:	Purpose of Review: Eosinophilic esophagitis is a chronic and commonly evolving condition leading to relevant and potentially irreversible burden in terms of tissue damage and related functional impairment, thus significantly impacting on quality of life. The aim of the present review is to summarize the recent advances in terms of diagnostic work-up and pharmacological and nonpharmacological management of the disease, under the broader perspective of type 2 inflammation. Recent Findings: Two major novelties have prompted an innovative approach to EoE. In terms of diagnosis, it has been proposed to dissect the disease heterogeneity in three endotypes, independent from tissue eosinophil number: EoEe1, characterized by normal appearing oesophagus; EoEe2, associated with type 2 inflammation and steroid-refractoriness; EoEe3, whose features include adult onset, a more fibro-stenotic aspect and loss of epithelial gene expression. Concerning treatment, two recently licensed drugs for EoE, oro-dispersible budesonide and dupilumab represent the first treatment options specifically developed for EoE and addressing EoE-related peculiar pathobiological features. Summary: In the era of precision medicine, managing EoE according to a phenotype-driven approach might be helpful in defining the best treatment options in the different disease forms or stages. In addition, exploring the coexistence or the previous occurrence of other type 2 conditions may suggest the opportunity to specifically target type 2 inflammation through biologic therapy. The complex EoE pathobiology combining inflammatory and functional features, both at organ and systemic level, requires a multidimensional approach relying on the strict integration of gastroenterologists and allergist-immunologists. (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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