EoE disease monitoring: Where we are and where we are going

Abstract

Objective: To review literature on various methods of monitoring and characterizing eosinophilic esophagitis (EoE) with respect to their validity as well as risk to the patient.

Data sources: A literature search was performed using PubMed with keyword combinations of EoE and monitoring as well as various techniques used for monitoring, including but not limited to, symptoms, endoscopy, histology, fluoroscopy, FLIP, noninvasive monitoring, and biomarkers.

Study selections: Case-control studies, observational studies, peer-reviewed reviews and guidelines, and systematic reviews were selected, reviewed, and summarized here.

Results: A wealth of research regarding monitoring of EoE is currently being undertaken and published. Our review highlights those that have been validated and are currently being used, as well as some that show promise for future monitoring and disease characterization.

Conclusion: Eosinophilic esophagitis is a chronic condition that at this time requires upper endoscopy as the gold standard of diagnosis and monitoring. There is a great need in the field for less invasive monitoring tools and better ways to characterize disease to allow for personalization of therapies.

Conflict of interest statement

Conflicts of interest: None

Copyright © 2019 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1:

Current and future modalities for monitoring in Eosinophilic Esophagitis

Figure 2:

Histologic changes in active Eosinophilic Esophagitis: in addition to eosinophilia, other mucosal and submucosal abnormalities include basal cell hyperplasia, dilated intercellular spaces, and lamina propria fibrosis.

Figure 3:

After the catheter is inserted and the balloon is inflated, a real time image of the esophagus appears on the FLIP monitor. The diameter is shown on the left and the balloon pressure at the bottom of the screen. Analysis is performed to determine the distensibility of the esophagus by taking the minimum diameter along the esophageal body at a pressure of 40mmHg accounting for peristalsis and respiration. This case represents a patient with EoE and lower esophageal narrowing not appreciated on endoscopy with a diameter of 9.95mm at a pressure of 40mmHg.