Future of therapy and monitoring for eosinophilic esophagitis and eosinophilic gastrointestinal diseases

Abstract

Eosinophilic gastrointestinal disorders, including eosinophilic esophagitis, are chronic T_H2-mediated diseases. Establishing a diagnosis and initiating treatment are crucial to limit disease progression that may lead to tissue remodeling and the development of strictures that significantly affect patients' quality of life. Expert consensus guidelines provide a framework for treating eosinophilic esophagitis with diet elimination, proton pump inhibitors, swallowed topical steroids, or dupilumab, and for monitoring with sedated endoscopy for gross and histologic evaluation. Although this provides an established algorithm for treating and monitoring eosinophilic esophagitis, there is less established research for the rarer eosinophilic gastrointestinal disorders (eosinophilic gastritis, enteritis, and colitis). Research advancements continue rapidly to emerge, identifying potential biomarkers, therapeutic targets, and monitoring strategies. In this article, we review the currently accepted methods for treating and monitoring eosinophilic gastrointestinal disorders with a focus on eosinophilic esophagitis, assess methods currently under investigation, and provide an aspirational vision for future disease management with a streamlined algorithm of personalized medicine and less invasive monitoring.