Evolving Management of Eosinophilic Esophagitis: From Diagnosis to Early Intervention - Episode 10
Monitoring Approaches for Different Treatments for EoE
Panelists discuss how monitoring eosinophilic esophagitis (EoE) involves short-term endoscopic evaluation at 2 to 6 months to assess symptom, histologic, and endoscopic response to treatment. This is followed by annual long-term follow-up visits to monitor adherence, address obstacles, and watch for adverse effects. They emphasize the chronic nature of the disease because EoE returns when treatment is discontinued.
Treatment monitoring for EoE employs a systematic approach evaluating 3 primary domains: symptomatic improvement, histological response through esophageal biopsies, and endoscopic appearance changes. The timing of initial response assessment varies by treatment modality, with proton pump inhibitors evaluated at 8 weeks, topical corticosteroids at 2 to 3 months, dupilumab at 4 to 6 months, and food elimination diets assessed every 6 to 8 weeks for each eliminated food category. These evaluations determine whether patients achieve remission or require treatment modifications.
Monitoring must distinguish between inflammatory and fibrostenotic disease components, as current therapies target inflammation but cannot reverse established scarring. Endoscopic assessment focuses on inflammatory features including edema, furrows, and exudates, which respond to medical therapy, whereas fibrostenotic changes may require mechanical interventions such as dilation. The evaluation process determines whether patients are responders in remission or need alternative therapeutic approaches.
Long-term management emphasizes annual clinical follow-up to maintain treatment adherence and monitor for complications. These visits provide opportunities to discuss emerging therapies, assess medication adherence, address insurance obstacles, and evaluate ongoing symptoms that might indicate a need for treatment optimization. Regular monitoring becomes particularly important given the chronic nature of EoE and the tendency for patients to discontinue therapy once symptoms improve, leading to disease recurrence. Long-term considerations include monitoring for treatment-related adverse effects, especially with newer biologic therapies where immune system targeting may potentially shift inflammatory patterns or contribute to other conditions. Young adult populations require special attention for care transitions, particularly in university settings where patients frequently relocate. Importantly, EoE differs from other childhood atopic conditions in that patients do not “grow out of” the disease, and discontinuation of any effective therapy typically results in disease recurrence, emphasizing the importance of maintaining long-term treatment adherence and regular clinical oversight.
