Conference Coverage

Presentation and Pathogenesis of EoE

In this video, Jonathan A. Bernstein, MD, speaks about the pathogenesis of eosinophilic esophagitis and reviews the recent guidelines from The American Gastroenterology Association for the management of patients with eosinophilic esophagitis. Dr Bernstein also spoke about these topics during his session titled “Presentation and Pathogenesis of EoE” at ACAAI Annual Scientific Meeting 2022.

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Jonathan A. Bernstein, MD, is a professor of clinical medicine at the University of Cincinnati College of Medicine in the Division of Rheumatology, Allergy and Immunology and Partner of Bernstein Allergy Group and Bernstein Clinical Research Center (Cincinnati, OH).



Dr Jonathan A. Bernstein: I'm Dr Jonathan Bernstein, Professor of Medicine at the University of Cincinnati, and Partner of Bernstein Allergy Group and Clinical Research Center.

This was a discussion of the pathogenesis of eosinophilic esophagitis and to also review the guidelines that were released last year by the joint task force in the American Gastroenterology Association. We basically provided a nice case presentation and discussed some of the presenting symptoms that patients develop. But quickly talked about the pathogenesis and natural progression of the disease. And then we talked about the progress in understanding the pathogenesis.

Then we basically progressed to talk about the discovery that led to ultimately a targeted treatment for EoE. And again, this spanned from the 1980s to the present time with work, identifying certain cytokines like the IL-4, IL-13, and then demonstrating their relevance in EoE, and then with different molecules that actually had some impact on changing some of the pathogenic features of EoE, and then the ultimate clinical trials that showed efficacy for dupilumab and potentially others to come.

There is a consensus on the diagnosis of EoE. It requires over 15 eosinophils per high power field on biopsy. And one of the key pathogenic features of EoE is disruption of the esophageal epithelial barrier that initiates the inflammatory response. And if this goes undiagnosed, inflammation can ultimately cause structural changes in the esophagus leading to strictures, fibrosis, and this is where people start having impactions and so forth. Screening requires an Esophagogastroduodenoscopy and biopsy as there not any non-invasive methods for diagnosis. These are things that have been worked on, but we don't have anything available at the present time. The only currently approved FDA therapy for EoE is dupilumab at the present time, which was just approved this year. And then the recent EoE guidelines indicate that most recommendations are conditional and of low to very low quality, indicating the need for better design studies to understand this condition.