Treatment of eosinophilic esophagitis has progressed from elemental formula for children and esophageal dilation for adults to selective exclusion of food triggers and swallowed topical corticosteroids. Management guidelines are available from the American Gastroenterological Association and the Joint Task Force on Allergy Immunology Practice Parameters. We cannot, however, evaluate the efficacy of treatments without a definition of response. We propose a treat-to-target approach, based on symptoms and findings from endoscopy and histology. This approach addresses dissociations between outcomes, such as symptom persistence despite normalization of histologic features and symptom resolution after esophageal dilation despite histologic features of active disease. Eosinophilic esophagitis can now be treated with biologic agents that target specific immune pathways, and findings from prospective trials have indicated that less-restrictive, empiric, elimination diets can be effective and reduce the need for repeated endoscopic assessment of disease activity during food reintroduction. We also discuss eosinophilic esophagitis subtypes, factors associated with disease, and advances in management.

中文翻译：

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儿童和成人嗜酸性食管炎患者的治疗方法和挑战。


嗜酸性粒细胞性食管炎的治疗已从儿童的元素配方和成人的食管扩张发展到选择性排除食物触发因素和吞咽外用皮质类固醇。管理指南可从美国胃肠病学协会和过敏免疫学实践参数联合工作组获得。然而，如果没有反应的定义，我们就无法评估治疗的效果。我们根据症状以及内窥镜和组织学的发现提出了一种靶向治疗方法。这种方法解决了结果之间的分离，例如尽管组织学特征正常化但症状持续存在，以及尽管活动性疾病的组织学特征食管扩张后症状消退。嗜酸性粒细胞性食管炎现在可以用针对特定免疫途径的生物制剂进行治疗，前瞻性试验的结果表明，限制较少的经验性消除饮食可以有效，并减少在重新引入食物期间对疾病活动进行重复内镜评估的需要。我们还讨论了嗜酸性粒细胞性食管炎的亚型、与疾病相关的因素以及治疗进展。