Treatment of eosinophilic esophagitis: literature review and own clinical observations

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Abstract

Eosinophilic esophagitis is a T2 disease characterized by eosinophilic infiltration of the esophageal mucosa, subepithelial and submucosal fibrosis, and progressive dysphagia. Early diagnosis and appropriate treatment of eosinophilic esophagitis can prevent the development of strictures and other complications. The treatment of eosinophilic esophagitis includes the use of elimination diets, pharmacological therapy, and endoscopic dilation or bougienage of the esophageal strictures. The most effective drugs for achieving clinical and histological remission in eosinophilic esophagitis are proton pump inhibitors, topical glucocorticosteroids, and biological agents represented by monoclonal antibodies. Over time, the advantages of systemic monoclonal antibody therapies (anti-interleukin 4/13) over proton pump inhibitors and topical glucocorticosteroids have become evident, particularly in terms of their impact on mucosal inflammation and on remodeling of the esophageal wall. Currently, the only approved anti-interleukin drug for eosinophilic esophagitis is dupilumab, which has demonstrated high efficacy and safety in clinical trials and is approved for use in children aged 1 year and older, as well as in adults. Endoscopic dilation or bougienage is performed in patients with eosinophilic esophagitis who have esophageal strictures and stenosis (with an esophageal diameter <13 mm) following a course of pharmacotherapy. To this day, numerous questions remain regarding maintenance therapy, its duration, and predictors of disease progression. With the emergence of new biologic therapies for eosinophilic esophagitis, their accessibility, long-term efficacy, and safety have become critically important considerations.

The article systemizes existing data on the treatment strategies for patients with eosinophilic esophagitis.

About the authors

Valeria O. Kaibysheva

The Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: valeriakai@mail.ru
ORCID iD: 0000-0003-0114-3700
SPIN-code: 3954-1379

MD, Cand. Sci. (Medicine)

Russian Federation, Moscow

Evgeniy D. Fedorov

The Russian National Research Medical University named after N.I. Pirogov

Email: efedo@mail.ru
ORCID iD: 0000-0002-6036-7061
SPIN-code: 6785-9959

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

Sergey G. Shapovalyants

The Russian National Research Medical University named after N.I. Pirogov

Email: sgs31@mail.ru
ORCID iD: 0000-0002-1571-8125
SPIN-code: 8510-5985

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Moscow

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2. Fig. 1. Results of pathological analysis of esophageal biopsy, haematoxylin and eosin staining: clusters of >15 eosinophilic leukocytes in the field of view, ×400

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3. Fig. 2. Endoscopic signs of eosinophilic esophagitis in patient A. before treatment: rings, stricture.

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4. Fig. 3. Endoscopic features of eosinophilic esophagitis in patient A during treatment: edema, rings, furrows.

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5. Fig. 4. Endoscopic features of eosinophilic esophagitis patient K. during treatment by dupilumab: rings, longitudinal furrows.

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