Joy Chang, MD, MS, is an assistant professor of medicine in the division of gastroenterology at the University of Michigan in Ann Arbor.

Joy Chang, MD, MS

Navigating the Evolving Eosinophilic Esophagitis Landscape, with Joy Chang, MD, MS

 has evolved drastically in a short time, transitioning from a newly recognized condition to one with FDA-approved therapies and growing clinical rapport. But with progress comes new complexity.

“We've only known about EoE for maybe 3 decades. In the grand scheme of all things medicine, it is such a young disease,” Joy Chang, MD, MS, an assistant professor of medicine in the division of gastroenterology at the University of Michigan in Ann Arbor, explained to 

. “In that process, we went from describing what this thing is to trying a sprinkle of proton pump inhibitors all the way to having 2 FDA-approved medications.”

In a recent review article, Chang provided historical context for the current landscape of pharmacologic treatments in EoE as well as perspectives on how future development may improve understanding and management of this complex disease. Even with recent advancements in EoE, she points to key knowledge gaps that persist—particularly around 

 treatments work for some patients and not others, and how best to tailor options to individual needs.

Specifically, she cites the frequent use of proton pump inhibitors as a first-line therapy but a lack of understanding as to why some people respond to them while others don’t. Additionally, as new EoE treatments continue to emerge, Chang points to the importance of being able to optimize and personalize treatment courses for patients, acknowledging not everyone with EoE experiences the same disease course.

“Not all patients are created equally. Their EoE is not always the same,” she said. “Some patients have mild disease, and some patients have very severe disease.”

Furthermore, Chang notes the need for methods for predicting which patients will progress to a more severe disease state more rapidly, helping clinicians decide when aggressive treatment is needed or when there is time to explore more patient-preferred options like dietary therapy.

Another evolving area is disease monitoring. Current methods rely on endoscopy and biopsies, which can be burdensome, but Chang highlights transnasal endoscopy, which avoids sedation, as a promising technique already gaining traction in pediatrics. Looking ahead, she says noninvasive tools like blood tests could further ease disease tracking.

Editors’ note: Chang has relevant disclosures with Takeda Pharmaceuticals, Sanofi-Regeneron, and Bristol Myers Squibb.

Min S, Chang JW. From Past to Present: The Evolution of Pharmacologic Therapies for Eosinophilic Esophagitis. 

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Chang reviews key points from her recent paper on the evolving landscape of eosinophilic esophagitis management and lingering knowledge gaps.

Joy Chang, MD, MS

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