Eosinophilic esophagitis-current and emerging management strategies

The main symptom of eosinophilic esophagitis (EoE) is dysphagia for solids. The diagnosis is made by taking staged biopsies from the esophagus, whereby the density of eosinophils must be >= 15 cells/high power field (HPF). Noninvasive methods confirming the diagnosis have not yet been established. The therapeutic spectrum of EoE can be broken down into the following three categories: medication (topically acting corticosteroids, proton pump inhibitors, biologics), elimination diets, and dilatation (bougienage of the esophagus). In addition to "classical" EoE, "EoE variants" are becoming increasingly common, i.e., cases of symptoms typical of EoE without evidence of relevant tissue eosinophilia. With the drugs approved today, 60-80% of patients are brought into remission (clinically and histologically). However, the range of medicines will be expanded again in the coming years. Among other things, topically effective immunosuppressants, monoclonal antibodies against thymic stromal lymphopoietin (TSLP), small molecules and S1P receptor modulators could find their way into EoE therapy.