Evan Dellon, MD, MPH, is a professor in the division of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at UNC School of Medicine.

Evan Dellon, MD, MPH

Key Advances and Ongoing Challenges in Eosinophilic Esophagitis, with Evan Dellon, MD, MPH

 is a chronic, immune-mediated disease of increasing clinical relevance, with recent advances transforming both its diagnosis and management. As the field rapidly evolves, new guidelines, assessment tools, and trial data are shaping how clinicians understand and treat the condition.

, Evan Dellon, MD, MPH, a professor in the division of gastroenterology and hepatology and director of the Center for Esophageal Diseases and Swallowing at UNC School of Medicine, indicated he is most excited about the recently released American College of Gastroenterology guidelines, which he says represent a major step forward by offering clinicians a unified, practical framework for diagnosis, treatment, and long-term monitoring.

“To me, that's really exciting to have sort of a culminating piece of a guideline right now in the field,” he said.

He points to the Index of Severity for EoE as another major development, noting how it draws from asthma care models to stratify patients based on symptoms, inflammation, and fibrostenotic changes. Together, he says these tools may help standardize care and improve outcomes.

Recent trial results, however, have complicated assumptions about disease mechanisms. Eosinophil-depleting therapies, while effective at reducing inflammation, have not consistently led to clinical improvement, suggesting eosinophils may not be the primary drivers of disease and that upstream allergic pathways and other immune cells may play more central roles.

“When we think about our treatments for EoE and identifying targets, these trials have probably shown us that we need to think broadly in our treatment targets, or think about maybe attacking multiple different cell types. That's been pretty interesting,” Dellon explained. “We're not going to rename the disease yet. It's still eosinophilic esophagitis and it's a great diagnostic biomarker, but as we think about future trials, we'll be thinking more closely about what the best outcomes are.”

Despite a plethora of progress seen in recent years, Dellon notes that barriers to optimal care remain, including diagnostic delays and limited access to approved therapies due to payer restrictions. As treatment options expand, he says better tools are needed to personalize therapy and predict disease progression—particularly to identify patients at risk for fibrostenotic complications early in their course.

“I think two of the areas where we really need more information, and they're related, are personalization of care and prediction of treatment course,” Dellon said, citing the need for ways to personalize treatment up front without doing the treatment course and stratify patients based on predicted disease severity at diagnosis. “I think researching those two aspects will really help us optimize how we approach therapy.”

Editors’ note: Dellon has relevant disclosures with Adare/Ellodi, Allakos, Arena/Pfizer, AstraZeneca, Ferring, GSK, Regeneron, Sanofi, Shire/Takeda, Abbvie, Alfasigma, Phathom, Target RWE, and others.

Dellon ES, Muir AB, Katzka DA, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. The American Journal of Gastroenterology. 

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Dellon describes what excites him most about EoE recently but points to barriers to optimal care as well as unanswered research questions and clinical needs.

Evan Dellon, MD, MPH

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