Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Feb 6, 2016; 7(1): 21-32
Published online Feb 6, 2016. doi: 10.4292/wjgpt.v7.i1.21
Recent discoveries and emerging therapeutics in eosinophilic esophagitis
Aakash Goyal, Edaire Cheng
Aakash Goyal, Department of Pediatrics, Division of Gastroenterology, Children’s Health Children’s Medical Center and University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, United States
Edaire Cheng, Department of Pediatrics and Internal Medicine, Division of Gastroenterology, Children’s Health Children’s Medical Center and University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, United States
Author contributions: All authors equally contributed to this paper with conception and drafting; Cheng E was responsible for critical revision, editing, and final approval of the final version.
Supported by The National Institutes of Health (K08-DK099383 to Cheng E); NASPGHAN Foundation/AstraZeneca Award (Cheng E); and AGA Research Scholar Award (Cheng E).
Conflict-of-interest statement: No conflicts of interest exist for any of the authors.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Edaire Cheng, MD, Assistant Professor, Department of Pediatrics and Internal Medicine, Division of Gastroenterology, Children’s Health Children’s Medical Center and University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9063, United States. edaire.cheng@utsouthwestern.edu
Telephone: +1-214-8570404 Fax: +1-214-6482096
Received: August 8, 2015
Peer-review started: August 11, 2015
First decision: September 18, 2015
Revised: October 13, 2015
Accepted: December 9, 2015
Article in press: December 11, 2015
Published online: February 6, 2016
Abstract

Eosinophilic esophagitis (EoE) is an allergy-mediated disease culminating in severe eosinophilic inflammation and dysfunction of the esophagus. This chronic disorder of the esophagus causes significant morbidity, poor quality of life, and complications involving fibrosis and esophageal remodeling. Overlapping features between EoE and gastroesophageal reflux disease (GERD) pose great challenges to differentiating the two conditions, although the two disorders are not mutually exclusive. Recent findings suggest that the confounding condition proton pump inhibitor - responsive esophageal eosinophilia (PPI-REE) is likely a subset of EoE. Since PPIs have therapeutic properties that can benefit EoE, PPIs should be considered as a therapeutic option for EoE rather than a diagnostic screen to differentiate GERD, PPI-REE, and EoE. Other current treatments include dietary therapy, corticosteroids, and dilation. Immunomodulators and biologic agents might have therapeutic value, and larger trials are needed to assess efficacy and safety. Understanding the pathophysiology of EoE is critical to the development of novel therapeutics.

Keywords: Eosinophilic esophagitis, Interleukin-5, Proton pump inhibitors, Proton pump inhibitor-responsive esophageal eosinophilia, Gastroesophageal reflux disease, Eotaxin-3

Core tip: In this review, we will discuss recent challenges and discoveries in eosinophilic esophagitis (EoE). While current treatment options are limited, mainly dietary therapy and steroids, we will highlight emerging therapeutics targeting pathogenic mechanisms of the disease. Although EoE is an allergy-mediated disease, the overlapping features of EoE and gastroesophageal reflux disease (GERD) present a diagnostic quandary in distinguishing the two disorders. EoE and GERD are not mutually exclusive and might share a complex relationship. We will review how proton pump inhibitor (PPI)s might exert therapeutic effects in EoE, and why a PPI response does not provide clear diagnostic distinction between EoE and GERD.