New Developments in the Diagnosis and Treatment of Eosinophilic Esophagitis

  • Quan M. NhuEmail author
  • Fouad J. MoawadEmail author
Esophagus (PG Iyer, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Esophagus


Purpose of review

Eosinophilic esophagitis (EoE) is a chronic, allergen-driven, immune-mediated disease of the esophagus that progresses to esophageal fibrostenosis if left untreated. The aim of this review is to provide a concise update on recent clinically relevant advances in the development of diagnostic and therapeutic approaches for EoE.

Recent findings

Current diagnostic and disease monitoring protocols for EoE rely on repetitive endoscopic evaluations and esophageal tissue acquisition for histopathologic analysis. Recent advancements in EoE diagnosis include endoscopic functional lumen imaging probe (FLIP), transnasal endoscopy (TNE), and the emergence of non-invasive diagnostic tools including cytosponge, esophageal string test, and mucosal impedance probe. Biomarkers for EoE have not yet proven their clinical utility. No Food and Drug Administration (FDA)-approved drugs currently exist for the treatment of EoE. Topical corticosteroid, proton-pump inhibitors (PPI), elimination diet, and dilation are the current treatment modalities for confirmed EoE. Promising results from clinical trials are emerging for biologic agents that target the interleukin (IL)-13 and the IL-4/IL-13 receptor, specifically, RPC4046 and dupilumab, respectively.


New diagnostic algorithms, non-invasive diagnostic strategies, and treatment modalities for EoE are emerging. Patients with EoE continue to require a multimodal and multi-disciplinary management approach.


Eosinophilic esophagitis (EoE) Diagnosis Treatment Corticosteroids Elimination diet Biologic therapy 



Absolute eosinophil count


Eosinophilic esophagitis


Functional lumen imaging probe


Four-food elimination diet


High-power field


Proton-pump inhibitor


PPI-responsive esophageal eosinophilia


Six-food elimination diet


Two-food elimination diet


Transnasal endoscopy


Funding Information

QMN is supported by Scripps Research Translational Institute NIH/NCATS CTSA Award 5 UL1 TR001114, 5KL2 TR001112, and by a CEGIR award. CEGIR (Consortium of Eosinophilic Gastrointestinal Disease Researchers; U54 AI117804) is part of the Rare Disease Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including APFED, CURED, and EFC. QMN and FJMare supported by Scripps Clinic and by Scripps ClinicMedical Group Research & Education Awards.

Compliance with Ethical Standards

Conflict of Interest

Quan Nhu and Fouad Moawad declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

  1. 1.
    Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018;154(2):319–33.e3.
  2. 2.
    O'Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT, et al. Pathophysiology of eosinophilic esophagitis. Gastroenterology. 2018;154(2):333–45. Scholar
  3. 3.
    Moawad FJ. eosinophilic esophagitis: incidence and prevalence. Gastrointest Endosc Clin N Am. 2018;28(1):15–25. Scholar
  4. 4.
    Shaheen NJ, Mukkada V, Eichinger CS, Schofield H, Todorova L, Falk GW. Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course. Dis Esophagus. 2018;31(8):doy015.
  5. 5.
    Dellon ES, Kim HP, Sperry SL, Rybnicek DA, Woosley JT, Shaheen NJ. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc. 2014;79(4):577–85.e4.
  6. 6.
    Furuta GT, Katzka DA. Eosinophilic esophagitis. N Engl J Med. 2015;373(17):1640–8. Scholar
  7. 7.
    • Warners MJ, RAB ON, de Wijkerslooth LRH, Smout A, Bredenoord AJ. The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort. Am J Gastroenterol. 2018;113(6):836–44. study evaluated the natural course of EoE in 721 patients that supports a progression from inflammatory to a fibrostenotic phenotype. The authors identified diagnostic delay and male gender as the major risk factors for stricture presence.CrossRefGoogle Scholar
  8. 8.
    •• Menard-Katcher C, Benitez AJ, Pan Z, Ahmed FN, Wilkins BJ, Capocelli KE, et al. Influence of Age and Eosinophilic Esophagitis on Esophageal Distensibility in a Pediatric Cohort. Am J Gastroenterol. 2017;112(9):1466–73. study showed that pathologic remodeling occurs in pediatric EoE and affects esophageal distensibility. The authors call for the need for early diagnosis and initiating therapy prior to onset of disease complications.CrossRefGoogle Scholar
  9. 9.
    Nhu QM, Aceves SS. Tissue remodeling in chronic eosinophilic esophageal inflammation: parallels in asthma and therapeutic perspectives. Front Med (Lausanne). 2017;4:128. Scholar
  10. 10.
    Lucendo AJ, Arias-Gonzalez L, Molina-Infante J, Arias A. Determinant factors of quality of life in adult patients with eosinophilic esophagitis. United European Gastroenterol J. 2018;6(1):38–45. Scholar
  11. 11.
    Mukkada V, Falk GW, Eichinger CS, King D, Todorova L, Shaheen NJ. Health-related quality of life and costs associated with eosinophilic esophagitis: a systematic review. Clin Gastroenterol Hepatol. 2018;16(4):495–503.e8.
  12. 12.
    Aceves SS, King E, Collins MH, Yang GY, Capocelli KE, Abonia JP, et al. Alignment of parent- and child-reported outcomes and histology in eosinophilic esophagitis across multiple CEGIR sites. J Allergy Clin Immunol. 2018;142(1):130–8.e1.
  13. 13.
    Lynch MK, Barnes MJ, Dimmitt RA, Martin L, Rothenberg ME, Goodin BR. Disease-related predictors of health-related quality of life in youth with eosinophilic esophagitis. J Pediatr Psychol. 2018;43(4):464–71. Scholar
  14. 14.
    Lynch MK, Dimmitt RA, Goodin BR. Evidence of disturbed sleep in children with eosinophilic esophagitis and persistent epigastric pain. J Pediatr Psychol. 2018;43(3):331–41. Scholar
  15. 15.
    Ettyreddy AR, Sink JR, Georg MW, Kitsko DJ, Simons JP. Association between eosinophilic esophagitis and esophageal food impaction in the pediatric population. Otolaryngol Head Neck Surg. 2018;159(4):750–4.
  16. 16.
    Sun RW, Bonilla-Velez J, Pesek RD, Johnson AB, Cleves MA, Richter GT. Eosinophilic esophagitis in children under the age of 5 years: clinical characteristics. Laryngoscope. 2018;128(4):798–805. Scholar
  17. 17.
    Falk GW. Clinical presentation of eosinophilic esophagitis in adults. Gastroenterol Clin N Am. 2014;43(2):231–42. Scholar
  18. 18.
    Paquet B, Begin P, Paradis L, Drouin E, Des RA. High rate of failure to thrive in a pediatric cohort with eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2016;116(1):73–4.e1.
  19. 19.
    Wolf WA, Piazza NA, Gebhart JH, Rusin S, Covey S, Higgins LL, et al. Association between body mass index and clinical and endoscopic features of eosinophilic esophagitis. Dig Dis Sci. 2017;62(1):143–9. Scholar
  20. 20.
    Mehta P, Furuta GT, Brennan T, Henry ML, Maune NC, Sundaram SS, et al. Nutritional state and feeding behaviors of children with eosinophilic esophagitis and gastroesophageal reflux disease. J Pediatr Gastroenterol Nutr. 2018;66(4):603–8. Scholar
  21. 21.
    Reed CC, Koutlas NT, Robey BS, Hansen J, Dellon ES. Prolonged time to diagnosis of eosinophilic esophagitis despite increasing knowledge of the disease. Clin Gastroenterol Hepatol. 2018;16(10):1667–9.
  22. 22.
    Leiman DA, Kochar B, Posner S, Fan C, Patel A, Shaheen O, et al. A diagnosis of eosinophilic esophagitis is associated with increased life insurance premiums. Dis Esophagus. 2018;31(8):doy008.
  23. 23.
    Godwin B, Liacouras C, Mehta V, Eisenberg J, Agawu A, Brown-Whitehorn T, et al. A review of tertiary referrals for management of pediatric esophageal eosinophilia. Front Pediatr. 2018;6:173. Scholar
  24. 24.
    Harris BR, Hon E, Gupta SK. Implementation of guidelines in eosinophilic esophagitis at an academic pediatric practice. Dis Esophagus. 2018;31(8):doy029.
  25. 25.
    Straumann A, Katzka DA. Diagnosis and treatment of eosinophilic esophagitis. Gastroenterology. 2018;154(2):346–59. Scholar
  26. 26.
    •• Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: Proceedings of the AGREE conference. Gastroenterology. 2018;155(4):1022–33.e10. AGREE conference updated the diagnostic algorithm for EoE, with removal of proton-pump inhibitor trial requirement for EoE diagnosis.
  27. 27.
    Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62(4):489–95. Scholar
  28. 28.
    Dellon ES, Cotton CC, Gebhart JH, Higgins LL, Beitia R, Woosley JT, et al. Accuracy of the eosinophilic esophagitis endoscopic reference score in diagnosis and determining response to treatment. Clin Gastroenterol Hepatol. 2016;14(1):31–9. Scholar
  29. 29.
    Wechsler JB, Bolton SM, Amsden K, Wershil BK, Hirano I, Kagalwalla AF. Eosinophilic esophagitis reference score accurately identifies disease activity and treatment effects in children. Clin Gastroenterol Hepatol. 2018;16(7):1056–63. Scholar
  30. 30.
    Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679–92.
  31. 31.
    • Wang J, Park JY, Huang R, Souza RF, Spechler SJ, Cheng E. Obtaining adequate lamina propria for subepithelial fibrosis evaluation in pediatric eosinophilic esophagitis. Gastrointest Endosc. 2018;87(5):1207–14.e3. This study reconfirmed that EoE is a patchy disease, but also identified that subepithelial fibrosis was already present in newly diagnosed EoE in children, which tended to appear in the middle or distal esophagus. The authors proposed that at least seven middle-distal esophageal biopsy specimens were required to optimally detect EoE subepithelial fibrosis.
  32. 32.
    • Friedlander JA, DeBoer EM, Soden JS, Furuta GT, Menard-Katcher CD, Atkins D, et al. Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis. Gastrointest Endosc. 2016;83(2):299–306.e1. study evaluated unsedated transnasal endoscopy (TNE) in EoE in a small cohort, but demonstrated that the procedure was feasible, preferred, and effective in monitoring the proximal esophageal mucosa of children with EoE.
  33. 33.
    Nelson MJ, Miller FH, Moy N, Zalewski A, Gonsalves N, Gregory DL, et al. Comparison of endoscopy and radiographic imaging for detection of esophageal inflammation and remodeling in adults with eosinophilic esophagitis. Gastrointest Endosc. 2018;87(4):962–8. Scholar
  34. 34.
    Hirano I, Pandolfino JE, Boeckxstaens GE. Functional lumen imaging probe for the management of esophageal disorders: expert review from the clinical practice updates Committee of the AGA Institute. Clin Gastroenterol Hepatol. 2017;15(3):325–34. Scholar
  35. 35.
    Ahuja NK, Clarke JO. The role of impedance planimetry in the evaluation of esophageal disorders. Curr Gastroenterol Rep. 2017;19(2):7. Scholar
  36. 36.
    •• Nicodeme F, Hirano I, Chen J, Robinson K, Lin Z, Xiao Y, et al. Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2013;11(9):1101–7.e1. study demonstrated in EoE patients that reduced esophageal distensibility could be used to predict food impaction risk and the need for esophageal dilation.
  37. 37.
    Lin Z, Kahrilas PJ, Xiao Y, Nicodeme F, Gonsalves N, Hirano I, et al. Functional luminal imaging probe topography: an improved method for characterizing esophageal distensibility in eosinophilic esophagitis. Ther Adv Gastroenterol. 2013;6(2):97–107. Scholar
  38. 38.
    Carlson DA, Hirano I, Zalewski A, Gonsalves N, Lin Z, Pandolfino JE. Improvement in esophageal distensibility in response to medical and diet therapy in eosinophilic esophagitis. Clin Transl Gastroenterol. 2017;8(10):e119. Scholar
  39. 39.
    • Katzka DA, Smyrk TC, Alexander JA, Geno DM, Beitia RA, Chang AO, et al. Accuracy and safety of the cytosponge for assessing histologic activity in eosinophilic esophagitis: a two-center study. Am J Gastroenterol. 2017;112(10):1538–44. This prospective two-center cross-sectional study showed that the minimally invasive cytosponge was safe, well tolerated, preferred by patients, and accurate, with the sensitivity and specificity of the cytosponge to assess EoE histologic activity being 75% and 86%, respectively.CrossRefGoogle Scholar
  40. 40.
    Katzka DA, Geno DM, Ravi A, Smyrk TC, Lao-Sirieix P, Miremadi A, et al. Accuracy, safety, and tolerability of tissue collection by cytosponge vs endoscopy for evaluation of eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2015;13(1):77–83.e2
  41. 41.
    • Furuta GT, Kagalwalla AF, Lee JJ, Alumkal P, Maybruck BT, Fillon S, et al. The oesophageal string test: a novel, minimally invasive method measures mucosal inflammation in eosinophilic oesophagitis. Gut. 2013;62(10):1395–405. This study demonstrated the novel, minimally invasive esophageal string test that measured eosinophil-derived proteins in luminal secretions to assess esophageal eosinophilic inflammation in pediatric EoE.CrossRefGoogle Scholar
  42. 42.
    Kern E, Lin D, Larson A, Yang GY, Taft T, Zalewski A, et al. Prospective assessment of the diagnostic utility of esophageal brushings in adults with eosinophilic esophagitis. Dis Esophagus. 2016;29(1):48–53. Scholar
  43. 43.
    Smadi Y, Deb C, Bornstein J, Safder S, Horvath K, Mehta D. Blind esophageal brushing offers a safe and accurate method to monitor inflammation in children and young adults with eosinophilic esophagitis. Dis Esophagus. 2018;31(12):doy056.
  44. 44.
    Kephart GM, Alexander JA, Arora AS, Romero Y, Smyrk TC, Talley NJ, et al. Marked deposition of eosinophil-derived neurotoxin in adult patients with eosinophilic esophagitis. Am J Gastroenterol. 2010;105(2):298–307. Scholar
  45. 45.
    Barrett C, Choksi Y, Vaezi MF. Mucosal impedance: a new approach to diagnosing gastroesophageal reflux disease and eosinophilic esophagitis. Curr Gastroenterol Rep. 2018;20(7):33. Scholar
  46. 46.
    Patel DA, Vaezi MF. Utility of esophageal mucosal impedance as a diagnostic test for esophageal disease. Curr Opin Gastroenterol. 2017;33(4):277–84. Scholar
  47. 47.
    • Choksi Y, Lal P, Slaughter JC, Sharda R, Parnell J, Higginbotham T, et al. Esophageal mucosal impedance patterns discriminate patients with eosinophilic esophagitis from patients with gerd. Clin Gastroenterol Hepatol. 2018;16(5):664–71.e1 study evaluated mucosal impedance measurements at 2, 5, and 10 cm from the squamocolumnar junction and demonstrated that EoE patients had a unique mucosal impedance pattern of low values along the esophageal axis.
  48. 48.
    Ates F, Yuksel ES, Higginbotham T, Slaughter JC, Mabary J, Kavitt RT, et al. Mucosal impedance discriminates GERD from non-GERD conditions. Gastroenterology. 2015;148(2):334–43. Scholar
  49. 49.
    • Lowry MA, Vaezi MF, Correa H, Higginbotham T, Slaughter JC, Acra S. Mucosal impedance measurements differentiate pediatric patients with active versus inactive eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2018;67(2):198–203. This study demonstrated that mucosal impedance was lower in active EoE at 2, 5, and 10 cm above the squamocolumnar junction, compared to inactive EoE, non-erosive reflux disease, and controls. The study supports that mucosal impedance is a promising rapid and less-invasive method to monitor EoE activity.CrossRefGoogle Scholar
  50. 50.
    Ishihara S, Shoda T, Ishimura N, Ohta S, Ono J, Azuma Y, et al. Serum biomarkers for the diagnosis of eosinophilic esophagitis and eosinophilic gastroenteritis. Intern Med. 2017;56(21):2819–25. Scholar
  51. 51.
    Dellon ES, Rusin S, Gebhart JH, Covey S, Higgins LL, Beitia R, et al. Utility of a noninvasive serum biomarker panel for diagnosis and monitoring of eosinophilic esophagitis: a prospective Study. Am J Gastroenterol. 2015;110(6):821–7. Scholar
  52. 52.
    Dellon ES, Higgins LL, Beitia R, Rusin S, Woosley JT, Veerappan R, et al. Prospective assessment of serum periostin as a biomarker for diagnosis and monitoring of eosinophilic oesophagitis. Aliment Pharmacol Ther. 2016;44(2):189–97. Scholar
  53. 53.
    Wright BL, Ochkur SI, Olson NS, Shim KP, Jacobsen EA, Rank MA, et al. Normalized serum eosinophil peroxidase levels are inversely correlated with esophageal eosinophilia in eosinophilic esophagitis. Dis Esophagus. 2018;31(2):dox139.
  54. 54.
    Min SB, Nylund CM, Baker TP, Ally M, Reinhardt B, Chen YJ, et al. Longitudinal evaluation of noninvasive biomarkers for eosinophilic esophagitis. J Clin Gastroenterol. 2017;51(2):127–35. Scholar
  55. 55.
    Hines BT, Rank MA, Wright BL, Marks LA, Hagan JB, Straumann A, et al. Minimally-invasive biomarker studies in eosinophilic esophagitis: a systematic review. Ann Allergy Asthma Immunol. 2018;121(2):218–28.
  56. 56.
    Erwin EA, Rhoda DA, Redmond M, Ly JB, Russo JM, Hill ID, et al. Using serum IgE antibodies to predict esophageal eosinophilia in children. J Pediatr Gastroenterol Nutr. 2017;65(5):520–5. Scholar
  57. 57.
    Clayton F, Fang JC, Gleich GJ, Lucendo AJ, Olalla JM, Vinson LA, et al. Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE. Gastroenterology. 2014;147(3):602–9. Scholar
  58. 58.
    Mohammad N, Avinashi V, Chan E, Vallance BA, Portales-Casamar E, Bush JW. Pediatric eosinophilic esophagitis is associated with increased lamina propria immunoglobulin G4-positive plasma cells. J Pediatr Gastroenterol Nutr. 2018;67(2):204–9.
  59. 59.
    Rosenberg CE, Mingler MK, Caldwell JM, Collins MH, Fulkerson PC, Morris DW, et al. Esophageal IgG4 levels correlate with histopathologic and transcriptomic features in eosinophilic esophagitis. Allergy. 2018;73(9):1892–1901.
  60. 60.
    Schuyler AJ, Wilson JM, Tripathi A, Commins SP, Ogbogu PU, Kruzsewski PG, et al. Specific IgG4 antibodies to cow's milk proteins in pediatric patients with eosinophilic esophagitis. J Allergy Clin Immunol. 2018;142(1):139–48.e12.
  61. 61.
    Dellon ES, Lin L, Beitia R, Moran TP, Qian Y. Serum autoantibodies against epithelial cell adhesion molecules as disease biomarkers of eosinophilic esophagitis. Clin Exp Allergy. 2018;48(3):343–6. Scholar
  62. 62.
    Nhu QM, Aceves SS. Medical and dietary management of eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2018;121(2):156–61. Scholar
  63. 63.
    Sastre J, Davila I. Dupilumab: a new paradigm for the treatment of allergic diseases. J Investig Allergol Clin Immunol. 2018;28(3):139–50. Scholar
  64. 64.
    Lipka S, Keshishian J, Boyce HW, Estores D, Richter JE. The natural history of steroid-naive eosinophilic esophagitis in adults treated with endoscopic dilation and proton pump inhibitor therapy over a mean duration of nearly 14 years. Gastrointest Endosc. 2014;80(4):592–8. Scholar
  65. 65.
    Runge TM, Eluri S, Woosley JT, Shaheen NJ, Dellon ES. Control of inflammation decreases the need for subsequent esophageal dilation in patients with eosinophilic esophagitis. Dis Esophagus. 2017;30(7):1–7. Scholar
  66. 66.
    Dellon ES, Sheikh A, Speck O, Woodward K, Whitlow AB, Hores JM, et al. Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis. Gastroenterology. 2012;143(2):321–4.e1.
  67. 67.
    Gupta SK, Vitanza JM, Collins MH. Efficacy and safety of oral budesonide suspension in pediatric patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2015;13(1):66–76.e3.
  68. 68.
    •• Miehlke S, Hruz P, Vieth M, Bussmann C, von Arnim U, Bajbouj M, et al. A randomised, double-blind trial comparing budesonide formulations and dosages for short-term treatment of eosinophilic oesophagitis. Gut. 2016;65(3):390–9. This study evaluated two different budesonide formulations, effervescent tablet for orodispersible use and viscous suspension, and demonstrated that both were highly effective and safe for short-term treatment of EoE, with patients preferring the effervescent tablet.CrossRefGoogle Scholar
  69. 69.
    Dohil R, Newbury R, Fox L, Bastian J, Aceves S. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Gastroenterology. 2010;139(2):418–29. Scholar
  70. 70.
    •• Butz BK, Wen T, Gleich GJ, Furuta GT, Spergel J, King E, et al. Efficacy, dose reduction, and resistance to high-dose fluticasone in patients with eosinophilic esophagitis. Gastroenterology. 2014;147(2):324–33.e5. This study demonstrated that high-dose fluticasone induced histologic remission after 3 months of treatment and that responders could have the dose reduced by 50% in 73 to 93% of the responding patients.
  71. 71.
    Straumann A, Miehlke S, Vieth M, Schlag C, von Arnim U, Molina-Infante J, et al. Sa1145 - predictors for early versus delayed response to budesonide orodispersible tablets in eosinophilic esophagitis treatment: a subgroup analysis from the pivotal trial eos-1. Gastroenterology. 2018;154(6):S-256–S-7. Scholar
  72. 72.
    Blanchard C, Mingler MK, Vicario M, Abonia JP, Wu YY, Lu TX, et al. IL-13 involvement in eosinophilic esophagitis: transcriptome analysis and reversibility with glucocorticoids. J Allergy Clin Immunol. 2007;120(6):1292–300. Scholar
  73. 73.
    Katzka DA, Tadi R, Smyrk TC, Katarya E, Sharma A, Geno DM, et al. Effects of topical steroids on tight junction proteins and spongiosis in esophageal epithelia of patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2014;12(11):1824–9.e1.
  74. 74.
    Simon D, Page B, Vogel M, Bussmann C, Blanchard C, Straumann A, et al. Evidence of an abnormal epithelial barrier in active, untreated and corticosteroid-treated eosinophilic esophagitis. Allergy. 2018;73(1):239–47. Scholar
  75. 75.
    • Andreae DA, Hanna MG, Magid MS, Malerba S, Andreae MH, Bagiella E, et al. Swallowed fluticasone propionate is an effective long-term maintenance therapy for children with eosinophilic esophagitis. Am J Gastroenterol. 2016;111(8):1187–97. This study demonstrated in pediatric EoE that long-term maintenance dosing of aerosolized and swallowed fluticasone was safe and that it improved histologic inflammation, lamina propria fibrosis, endoscopic features, and clinical symptoms.CrossRefGoogle Scholar
  76. 76.
    Fable JM, Fernandez M, Goodine S, Lerer T, Sayej WN. Retrospective comparison of fluticasone propionate and oral viscous budesonide in children with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2018;66(1):26–32. Scholar
  77. 77.
    Reed CC, Fan C, Koutlas N, Stefanadis Z, Eluri S, Shaheen NJ, et al. Compounded oral viscous budesonide is effective and provides a durable response in eosinophilic esophagitis. HSOA J Gastroenterol Hepatol Res. 2018;7(1):2509–15.CrossRefGoogle Scholar
  78. 78.
    • Greuter T, Bussmann C, Safroneeva E, Schoepfer AM, Biedermann L, Vavricka SR, et al. Long-term treatment of eosinophilic esophagitis with swallowed topical corticosteroids: development and evaluation of a therapeutic concept. Am J Gastroenterol. 2017;112(10):1527–35. This study proposed the concept of deep remission as a therapeutic goal for EoE and also proposed and evaluated an induction-maintenance corticosteroid protocol for EoE.CrossRefGoogle Scholar
  79. 79.
    Rubinstein E, Hait EE, Mitchell PD, Lee JJ. Every-other-day dosing of oral viscous budesonide is not effective in the management of eosinophlic esophagitis. J Pediatr Gastroenterol Nutr. 2018;66(3):395–7. Scholar
  80. 80.
    Lindberg GM, Van Eldik R, Saboorian MH. A case of herpes esophagitis after fluticasone propionate for eosinophilic esophagitis. Nat Clin Pract Gastroenterol Hepatol. 2008;5(9):527–30. Scholar
  81. 81.
    Alexander JA. Steroid treatment of eosinophilic esophagitis in adults. Gastroenterol Clin N Am. 2014;43(2):357–73. Scholar
  82. 82.
    Hsu S, Wood C, Pan Z, Rahat H, Zeitler P, Fleischer D, et al. Adrenal insufficiency in pediatric eosinophilic esophagitis patients treated with swallowed topical steroids. Pediatr Allergy Immunol Pulmonol. 2017;30(3):135–40. Scholar
  83. 83.
    Philpott H, Dougherty MK, Reed CC, Caldwell M, Kirk D, Torpy DJ, et al. Systematic review: adrenal insufficiency secondary to swallowed topical corticosteroids in eosinophilic oesophagitis. Aliment Pharmacol Ther. 2018;47(8):1071–8. Scholar
  84. 84.
    Dellon ES, Speck O, Woodward K, Gebhart JH, Madanick RD, Levinson S, et al. Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study. Am J Gastroenterol. 2013;108(12):1854–60. Scholar
  85. 85.
    Molina-Infante J, Lucendo AJ. Proton pump inhibitor therapy for eosinophilic esophagitis: a paradigm shift. Am J Gastroenterol. 2017;112(12):1770–3. Scholar
  86. 86.
    Shoda T, Matsuda A, Nomura I, Okada N, Orihara K, Mikami H, et al. Eosinophilic esophagitis versus proton pump inhibitor-responsive esophageal eosinophilia: transcriptome analysis. J Allergy Clin Immunol. 2017;139(6):2010–13.e4.
  87. 87.
    Molina-Infante J, Bredenoord AJ, Cheng E, Dellon ES, Furuta GT, Gupta SK, et al. Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut. 2016;65(3):524–31. Scholar
  88. 88.
    Moawad FJ, Schoepfer AM, Safroneeva E, Ally MR, Chen YJ, Maydonovitch CL, et al. Eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia have similar clinical, endoscopic and histological findings. Aliment Pharmacol Ther. 2014;39(6):603–8. Scholar
  89. 89.
    Zhang X, Cheng E, Huo X, Yu C, Zhang Q, Pham TH, et al. Omeprazole blocks STAT6 binding to the eotaxin-3 promoter in eosinophilic esophagitis cells. PLoS One. 2012;7(11):e50037. Scholar
  90. 90.
    • Cheng E, Zhang X, Huo X, Yu C, Zhang Q, Wang DH, et al. Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD. Gut. 2013;62(6):824–32. This study demonstrated that omeprazole inhibited IL-4/IL-13-induced eotaxin-3 expression in esophageal squamous epithelial cells, suggesting that PPI therapy has therapeutic potential beyond acid suppression.CrossRefGoogle Scholar
  91. 91.
    • Lucendo AJ, Arias A, Molina-Infante J. Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2016;14(1):13–22.e1. meta-analysis of 33 studies of 188 children and 431 adult patients with symptomatic esophageal eosinophilia showed that PPI therapy induced clinical and histologic remission in 60.8% and 50.5% of the patients, respectively.
  92. 92.
    Molina-Infante J, Prados-Manzano R, Gonzalez-Cordero PL. The role of proton pump inhibitor therapy in the management of eosinophilic esophagitis. Expert Rev Clin Immunol. 2016;12(9):945–52. Scholar
  93. 93.
    Gutierrez-Junquera C, Fernandez-Fernandez S, Cilleruelo ML, Rayo A, Echeverria L, Borrell B, et al. Long-term treatment with proton pump inhibitors is effective in children with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2018;67(2):210–6.
  94. 94.
    Gonsalves N, Yang GY, Doerfler B, Ritz S, Ditto AM, Hirano I. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology. 2012;142(7):1451–9.e1.
  95. 95.
    Lieberman JA, Morotti RA, Konstantinou GN, Yershov O, Chehade M. Dietary therapy can reverse esophageal subepithelial fibrosis in patients with eosinophilic esophagitis: a historical cohort. Allergy. 2012;67(10):1299–307. Scholar
  96. 96.
    Arias A, Gonzalez-Cervera J, Tenias JM, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014;146(7):1639–48. Scholar
  97. 97.
    Warners MJ, Vlieg-Boerstra BJ, Verheij J, van Hamersveld PHP, van Rhijn BD, Van Ampting MTJ, et al. Esophageal and small intestinal mucosal integrity in eosinophilic esophagitis and response to an elemental diet. Am J Gastroenterol. 2017;112(7):1061–71. Scholar
  98. 98.
    Warners MJ, Vlieg-Boerstra BJ, Verheij J, van Rhijn BD, Van Ampting MT, Harthoorn LF, et al. Elemental diet decreases inflammation and improves symptoms in adult eosinophilic oesophagitis patients. Aliment Pharmacol Ther. 2017;45(6):777–87. Scholar
  99. 99.
    Kagalwalla AF, Wechsler JB, Amsden K, Schwartz S, Makhija M, Olive A, et al. Efficacy of a 4-food elimination diet for children with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2017;15(11):1698–707.e7.
  100. 100.
    Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4(9):1097–102. Scholar
  101. 101.
    Molina-Infante J, Martin-Noguerol E, Alvarado-Arenas M, Porcel-Carreno SL, Jimenez-Timon S, Hernandez-Arbeiza FJ. Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic esophagitis. J Allergy Clin Immunol. 2012;130(5):1200–2. Scholar
  102. 102.
    Eckmann JD, Ravi K, Katzka DA, Davis DR, See JA, Geno DR, et al. Efficacy of atopy patch testing in directed dietary therapy of eosinophilic esophagitis: a pilot study. Dig Dis Sci. 2018;63(3):694–702. Scholar
  103. 103.
    •• Warners MJ, Terreehorst I, van den Wijngaard RM, Akkerdaas J, van Esch B, van Ree R, et al. Abnormal responses to local esophageal food allergen injections in adult patients with eosinophilic esophagitis. Gastroenterology. 2018;154(1):57–60.e2. novel study evaluated esophageal mucosal food allergen injection in a small cohort and showed induction of acute and/or delayed responses in EoE patients but not in non-EoE controls.
  104. 104.
    •• Molina-Infante J, Arias A, Alcedo J, Garcia-Romero R, Casabona-Frances S, Prieto-Garcia A, et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study. J Allergy Clin Immunol. 2018;141(4):1365–72. This study proposed and evaluated the 2-4-6 step up elimination diet therapy protocol for EoE which was effective and identified food triggers of EoE early, resulting in less unnecessary dietary restrictions, less number of endoscopic evaluations, and a shorter diagnostic process.
  105. 105.
    Philpott H, Dellon E. Histologic improvement after 6 weeks of dietary elimination for eosinophilic esophagitis may be insufficient to determine efficacy. Asia Pac Allergy. 2018;8(2):e20. Scholar
  106. 106.
    Richter JE. Esophageal dilation in eosinophilic esophagitis. Best Pract Res Clin Gastroenterol. 2015;29(5):815–28. Scholar
  107. 107.
    Lipka S, Kumar A, Richter JE. Successful esophageal dilation of eosinophilic esophagitis (EoE) patients with a previous postdilation complication: start low and go slow. J Clin Gastroenterol. 2018;52(9):773–7.
  108. 108.
    Runge TM, Eluri S, Cotton CC, Burk CM, Woosley JT, Shaheen NJ, et al. Outcomes of esophageal dilation in eosinophilic esophagitis: safety, efficacy, and persistence of the fibrostenotic phenotype. Am J Gastroenterol. 2016;111(2):206–13. Scholar
  109. 109.
    Lucendo AJ, Molina-Infante J. Esophageal dilation in eosinophilic esophagitis: risks, benefits, and when to do it. Curr Opin Gastroenterol. 2018;34(4):226–32. Scholar
  110. 110.
    Menard-Katcher C, Furuta GT, Kramer RE. Dilation of pediatric eosinophilic esophagitis: adverse events and short-term outcomes. J Pediatr Gastroenterol Nutr. 2017;64(5):701–6. Scholar
  111. 111.
    Moawad FJ, Molina-Infante J, Lucendo AJ, Cantrell SE, Tmanova L, Douglas KM. Systematic review with meta-analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis. Aliment Pharmacol Ther. 2017;46(2):96–105. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Gastroenterology & HepatologyScripps ClinicLa JollaUSA
  2. 2.Scripps Research Translational InstituteThe Scripps Research InstituteLa JollaUSA

Personalised recommendations