Treatment of Eosinophilic Esophagitis: Overview, Current Limitations, and Future Direction

Eosinophilic esophagitis (EE) is an increasingly recognized syndrome presenting with upper gastrointestinal (UGI) symptoms in association with hypereosinophilia (>15 eosinophils/HPF) on esophageal mucosal biopsies. The pathogenesis is unknown, but the candidate etiologies include food and aeroallergen hypersensitivity and an unusual presentation of gastroesophageal reflux disease. This review will highlight the treatments of EE in children and adults. Current treatments are controversial, few data are available in adults, and long-term studies are almost nonexistent. We outline the limitations in the current studies and suggest seven major issues in the study design that must be addressed in future drug trials.