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Treatment of Eosinophilic Esophagitis with Biological Agents

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Eosinophilic Esophagitis

Part of the book series: Clinical Gastroenterology ((CG))

Abstract

Traditional therapies for eosinophilic esophagitis have focused on dietary modifications and/or anti-inflammatory treatments, primarily systemic or topical glucocorticoids. However, both such approaches are difficult to maintain for both patients and clinicians. Elemental diets, containing amino acids as a protein substitute plus simple carbohydrates and fatty acids, are effective in up to 98% of children, but due to poor palatability and cost, these diets often are not sustainable. A six-food elimination diet is effective in up to 78% of children and of adults, but this diet is limited by significant noncompliance. Subsequently, clinicians have focused on the use of medications able to suppress inflammation for eosinophilic esophagitis (EoE). The biopsies from the distal esophagus appeared more resistant to fluticasone administration arguing that perhaps the resistance to this therapy was related to the route of administration. Presently, the efficacy of suspension and viscous formulations of steroids are under investigation for EoE. However, although the side effects seen in the recent trials of swallowed topical budesonide suspensions have been minimal and systemic absorption of budesonide and fluticasone from the gastrointestinal tract also is minimal, concerns remain over possible candidal esophagitis and adrenal suppression associated with prolonged use of steroids. Additionally, a substantial number of children and adults are refractory to steroid administration and continue to suffer from ongoing dysphagia and chest pain.

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Author information

Authors and Affiliations

  1. Department of Gastroenterology, University of Utah Hospital, Salt Lake City, UT, USA

    Kathryn A. Peterson MD, MSci (Epid) (Assistant Professor of Medicine)

  2. Department of Pediatric Gastroenterology, Hepatology, and Nutrition, Primary Children’s Medical Center and University of Utah Hospital, Salt Lake City, UT, USA

    Molly O’Gorman MD (Associate Professor of Pediatrics)

  3. Department of Pediatric Gastroenterology and Nutrition, University of Utah School of Medicine, Salt Lake City, UT, USA

    W. Daniel Jackson MD (Clinical Professor of Pediatrics)

  4. Department of Dermatology, University of Utah Hospital, 30 North 1900 East, Salt Lake City, UT, 84132, USA

    Gerald J. Gleich MD

Authors
  1. Kathryn A. Peterson MD, MSci (Epid)
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  2. Molly O’Gorman MD
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  3. W. Daniel Jackson MD
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  4. Gerald J. Gleich MD
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Corresponding author

Correspondence to Gerald J. Gleich MD .

Editor information

Editors and Affiliations

  1. The Children’s Hospital of Philadelphia, Center for Pediatric Eosinophilic Disord, The Univeristy of Pennsylvania School of, 34th Street & Civic Center Blvd., Philadelphia, 19104, Pennsylvania, USA

    Chris A. Liacouras

  2. University Medical Center, Pediatric Gastroenterology and Nutrition, Greenville Hospital System, Patewood Drive 200, Greenville, 29615, South Carolina, USA

    Jonathan E. Markowitz

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Peterson, K.A., O’Gorman, M., Jackson, W.D., Gleich, G.J. (2012). Treatment of Eosinophilic Esophagitis with Biological Agents. In: Liacouras, C., Markowitz, J. (eds) Eosinophilic Esophagitis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-60761-515-6_27

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  • DOI: https://doi.org/10.1007/978-1-60761-515-6_27

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  • Publisher Name: Humana Press

  • Print ISBN: 978-1-60761-514-9

  • Online ISBN: 978-1-60761-515-6

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