Eosinophile Ösophagitis Update 2017: Neue Leitlinien der europäischen Studiengruppe EUREOS

Stephan Miehlke; Christoph Schlag; Martin Storr; Ulrike von Arnim

doi:10.1055/a-0960-6553

Laryngo-Rhino-Otologie, Table of Contents

Laryngorhinootologie 2019; 98(11): 764-775
DOI: 10.1055/a-0960-6553

Übersicht

Eosinophile Ösophagitis Update 2017: Neue Leitlinien der europäischen Studiengruppe EUREOS

Eosinophilic Esophagitis Update: New Guidelines of the European Study Group EUREOS

Authors

Stephan Miehlke

¹Magen-Darm-Zentrum, Facharztzentrum Eppendorf, Hamburg, Germany
Christoph Schlag

²II. Med. Klinik, Klinikum Rechts der Isar, Technische Universität, München, Germany
Martin Storr

³Zentrum für Endoskopie, Internistenzentrum, Starnberg, Germany
Ulrike von Arnim

⁴Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Germany

Abstract

Zusammenfassung

Die eosinophile Ösophagitis gilt heute als eine der häufigsten Erkrankungen der Speiseröhre und eine der häufigsten Ursachen für Dysphagie und Bolusobstruktion bei Kindern und Erwachsenen. Die zunehmende Bedeutung dieser Erkrankung und neue klinisch-wissenschaftliche Erkenntnisse erforderten eine Aktualisierung der bis dato existierenden internationalen Leitlinien. Die europäische Studiengruppe Eosinophile Ösophagitis (EUREOS) hat daher, erstmals unter Verwendung der GRADE-Technik (Grading of Recommendations Assessment, Development, and Evaluation) mit Beteiligung aller relevanten Fachdisziplinen auf der Basis einer systematischen Literaturrecherche bis August 2015 neue Leitlinien zum Management der eosinophilen Ösophagitis bei Kindern und Erwachsenen erarbeitet. Das Ziel dieses Artikels ist es, die wichtigsten Neuerungen und klinische relevanten Empfehlungen der neuen Leitlinie zusammenzufassen und zu kommentieren.

Abstract

Eosinophilic esophagitis is now considered to be a frequent chronic esophageal disease and is one of the most common causes for dysphagia and bolus obstruction in children and adults. The increasing significance and new scientific insights in this disorder required an update of currently existing guidelines. Therefore, the European Study Group of Eosinophilic Esophagitis (EUREOS) has elaborated new guidelines for the management of eosinophilic esophagitis, based on a systematic literature search and, for the first time, using the GRADE methodology (Grading of Recommendations Assessment, Development, and Evaluation). The aim of the present article is to summarize and comment on new developments and clinical recommendations of this guideline to further increase the awareness for this relevant esophageal disease.

Schlüsselwörter

Eosinophile Ösophagitis - Dysphagie - Bolusobstruktion

Key words

Eosinophilic esophagitis - dysphagia - bolus obstruction

Full Text

References

Literatur
1 Furuta GT, Katzka DA. Eosinophilic Esophagitis. N Engl J Med 2015; 373: 1640-1648
2 Arias A, Perez-Martinez I, Tenias JM. et al. Systematic review with metaanalysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 2016; 43: 3-15
3 Furuta GT, Liacouras CA, Collins MH. et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007; 133: 1342-1363
4 Liacouras CA, Furuta GT, Hirano I. et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128: 3-20
5 Papadopoulou A, Koletzko S, Heuschkel R. et al. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 2014; 58: 107-118
6 Dellon ES, Gonsalves N, Hirano I. et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 2013; 108: 679-692
7 Lucendo AJ, Molina-Infante J, Arias A. et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017; 5: 335-358
8 Attwood SE, Smyrk TC, Demeester TRJJ. Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993; 38: 109-116
9 Molina-Infante J, Ferrando-Lamana L, Ripoll C. et al. Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults. Clin Gastroenterol Hepatol 2011; 9: 110-117
10 Molina-Infante J, Bredenoord AJ, Cheng E. et al. Proton pump inhibitorresponsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut 2016; 65: 524-531
11 Francis DL, Foxx-Orenstein A, Arora AS. et al. Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2012; 35: 300-307
12 Vazquez-Elizondo G, Ngamruengphong S, Khrisna M. et al. The outcome of patients with oesophageal eosino- philic infiltration after an eightweek trial of a proton pump inhibitor. Aliment Pharmacol Ther 2013; 38: 1312-1319
13 Dellon ES, Speck O, Woodward K. et al. Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study. Am J Gastroenterol 2013; 108: 1854-1860
14 Moawad FJ, Wells JM, Johnson RL. et al. Comparison of eotaxin-3 biomarker in patients with eosinophilic oesophagitis, proton pump inhibitor-responsive oesopha- geal eosinophilia and gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2015; 42: 231-238
15 Wen T, Dellon ES, Moawad FJ. et al. Transcriptome analysis of proton pump inhibitor-responsive esophageal eosinophilia reveals proton pump inhibitor- reversible allergic inflammation. J Allergy Clin Immunol 2015; 135: 187-197
16 Cheng E, Zhang X, Huo X. et al. Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD. Gut 2013; 62: 824-832
17 Spechler SJ, Genta RM, Souza RF. Thoughts on the complex relationship between gastroesophageal reflux disease and eosinophilic esophagitis. Am J Gastroenterol 2007; 102: 1301-1306
18 Krarup AL, Villadsen GE, Mejlgaard E. et al. Acid hypersensitivity in patients with eosinophilic oesophagitis. Scand J Gastroenterol 2010; 45: 273-281
19 Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology?. J Allergy Clinical immunol 2005; 115: 418-419
20 Hruz P, Straumann A, Bussmann C. et al. Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. Journal Allergy Clin immunol 2011; 128: 1349-1350.e5
21 Arias A, Lucendo AJ. Prevalence of eosinophilic oesophagitis in adult patients in a central region of Spain. Eur J Gastroenterol Hepatol 2013; 25: 208-212
22 Giriens B, Yan P, Safroneeva E. et al. Escalating incidence of eosinophilic esophagitis in Canton of Vaud, Switzerland, 1993–2013: a populationbased study. Allergy 2015; 70: 1633-1639
23 Soon IS, Butzner JD, Kaplan GG. et al. Incidence and prevalence of eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr 2013; 57: 72-80
24 Veerappan GR, Perry JL, Duncan TJ. et al. Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study. Clin Gastroenterol Hepatol 2009; 7: 420-426
25 Foroutan M, Norouzi A, Molaei M. et al. Eosinophilic esophagitis in patients with refractory gastroesophageal reflux disease. Dig Dis Sci 2010; 55: 28-31
26 Salem SB, Kushner Y, Marcus V. et al. The potential impact of contemporary developments in the management of patients with gastroesophageal reflux disease undergoing an initial gastroscopy. Can J Gastroenterol 2009; 23: 99-104
27 Achem SR, Almansa C, Krishna M. et al. Oesophageal eosinophilic infiltration in patients with noncardiac chest pain. Aliment Pharmacol Ther 2011; 33: 1194-1201
28 Dellon ES, Jensen ET, Martin CF. et al. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol 2014; 12: 589-596.e1
29 Kapel RC, Miller JK, Torres C. et al. Eosinophilic esophagitis: a prevalent disease in the United States that affects all age groups. Gastroenterology 2008; 134: 1316-1321
30 Alexander ES, Martin LJ, Collins MH. et al. Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis. J Allergy Clin Immunol 2014; 134: 1084-1092
31 González-Cervera J, Arias Á, Redondo-González O. The association between atopic manifestations and eosinophilic esophagitis: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2017; 118: 582-590
32 Almansa C, Krishna M, Buchner AM. et al. Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults. Am J Gastroenterol 2009; 104: 828-833
33 Lucendo AJ, Arias A, Tenias JM. Relation between eosinophilic esophagitis and oral immunotherapy for food allergy: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2014; 113: 624-629
34 Helou E, Simonson J, Arora A. 3-yr-follow-up of topical corticosteroid treatment for eosinophilic esophagitis in adults. Am J Gastroenterol 2008; 103: 2194-1299
35 Schoepfer AM, Safroneeva E, Bussmann C. et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a timedependent manner. Gastroenterology 2013; 145: 1230-1232
36 Lipka S, Kumar A, Richter JE. Impact of Diagnostic Delay and Other Risk Factors on Eosinophilic Esophagitis Phenotype and Esophageal Diameter. J Clin Gastroenterol 2016; 50: 134-140
37 van Rhijn BD, Oors JM, Smout AJPM. et al. Prevalence of esophageal motility abnormalities increases with longer disease duration in adult patients with eosinophilic esophagitis. Neurogastroenterol Motil 2014; 26: 1349-1355
38 Klinnert MD, Silveira L, Harris R. et al. Health-related quality of life over time in children with eosinophilic esophagitis and their families. J Pediatr Gastroenterol Nutr 2014; 59: 308-316
39 Safroneeva E, Coslovsky M, Kuehni CE. et al. Eosinophilic oesophagitis: relationship of quality of life with clinical, endoscopic and histological activity. Aliment Pharmacol Ther 2015; 42: 1000-1010
40 Lipka S, Keshishian J, Boyce HW. et al. The natural history of steroid-naive eosinophilic esophagitis in adults treated with endoscopic dilation and proton pump inhibitor therapy over a mean duration of nearly 14 years. Gastrointest Endosc 2014; 80: 592-598
41 Dellon ES, Gibbs WB, Fritchie KJ. et al. Clinical, endoscopic, and histologic findings distinguish eosinophilic esophagitis from gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2009; 7: 1305-1313
42 Remedios M, Campbell C, Jones DM. et al. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc 2006; 63: 3-12
43 Croese J, Fairley SK, Masson JW. et al. Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc 2003; 58: 516-522
44 Kahn J, Bussmann C, Beglinger C. et al. Exercise-induced chest pain: an atypical manifestation of eosinophilic esophagitis. Am J Med 2015; 128: 196-199
45 Spergel JM, Brown-Whitehorn TF, Beausoleil JL. et al. 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr 2009; 48: 30-36
46 Schoepfer AM, Straumann A, Panczak R. et al. Development and validation of a symptom-based activity index for adults with eosinophilic esophagitis. Gastroenterology 2014; 147: 1255-1266
47 Dellon ES, Irani AM, Hill MR. et al. Development and field testing of a novel patient-reported outcome measure of dysphagia in patients with eosinophilic esophagitis. Aliment Pharmacol Ther 2013; 38: 634-642
48 Martin LJ, Franciosi JP, Collins MH. et al. Pediatric Eosinophilic Esophagitis Symptom Scores (PEESS v2.0) identify histologic and molecular correlates of the key clinical features of disease. J Allergy Clin Immunol 2015; 135: 1519-1528
49 Franciosi JP, Hommel KA, Bendo CB. et al. Peds QL eosinophilic esophagitis module: Feasibility, reliability and validity. J Pediatr Gastroenterol Nutr 2013; 57: 57-66
50 Hirano I, Moy N, Heckman MG. et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-495
51 Dellon ES, Cotton CC, Gebhart JH. et al. Accuracy of the eosinophilic esophagitis endoscopic reference score in diagnosis and determining response to rreatment. Clin Gastroenterol Hepatol 2016; 14: 31-39
52 van Rhijn BD, Warners MJ, Curvers WL. et al. Evaluating the endoscopic reference score for eosinophilic esophagitis: moderate to substantial intra- and interobserver reliability. Endoscopy 2014; 46: 1049-1055
53 Kim HP, Vance RB, Shaheen NJ. et al. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 988-996
54 Safroneeva E, Straumann A, Coslovsky M. et al. Symptoms have modest accuracy in detecting endoscopic and histologic remission in adults with eosinophilic esophagitis. Gastroenterology 2016; 150: 581-590
55 Kwiatek MA, Hirano I, Kahrilas PJ. et al. Mechanical properties of the esophagus in eosinophilic esophagitis. Gastroenterology 2011; 140: 82-90
56 Nicodeme F, Hirano I, Chen J. et al. Esophageal distensibility as a measure of disease severity in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2013; 11: 1101-1107
57 Gonsalves N, Policarpio-Nicolas M, Zhang Q. et al. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc 2006; 64: 313-319
58 Saffari H, Peterson KA, Fang JC. et al. Patchy eosinophil distributions in an esophagectomy specimen from a patient with eosinophilic esophagitis: Implications for endoscopic biopsy. J Allergy Clin Immunol 2012; 130: 798-800
59 Nielsen JA, Lager DJ, Lewin M. et al. The optimal number of biopsy fragments to establish a morphologic diagnosis of eosinophilic esophagitis. Am J Gastroenterol 2014; 109: 515-520
60 Collins MH. Histopathologic features of eosinophilic esophagitis and eosinophilic gastrointestinal diseases. Gastroenterol Clin North Am 2014; 43: 257-268
61 Collins MH, Martin LJ, Alexander ES. et al. Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring. Dis Esophagus 2017; 30: 1-8
62 Konikoff MR, Blanchard C, Kirby C. et al. Potential of blood eosinophils, eosinophil-derived neurotoxin, and eotaxin-3 as biomarkers of eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006; 4: 1328-1336
63 Schlag C, Miehlke S, Heiseke A. et al. Peripheral blood eosinophils and other non-invasive biomarkers can monitor treatment response in eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 42: 1122-1130
64 Furuta GT, Kagalwalla AF, Lee JJ. et al. The oesophageal string test: a novel, minimally invasive method measures mucosal inflammation in eosinophilic oesophagitis. Gut 2013; 62: 1395-1405
65 Katzka DA, Geno DM, Ravi A. et al. Accuracy, safety, and tolerability of tissue collection by Cytosponge vs endoscopy for evaluation of eosinophilic esophagitis. Clin Gastroenterol Hepatol 2015; 13: 77-83
66 Markowitz JE, Spergel JM, Ruchelli E. et al. Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol 2003; 98: 777-782
67 Peterson KA, Byrne KR, Vinson LA. et al. Elemental diet induces histologic response in adult eosinophilic esophagitis. Am J Gastroenterol 2013; 108: 759-766
68 Spergel JM, Beausoleil JL, Mascarenhas M. et al. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol 2002; 109: 363-368
69 Wolf WA, Jerath MR, Sperry SLW. et al. Dietary elimination therapy is an effective option for adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2014; 12: 1272-1279
70 Molina-Infante J, Martin-Noguerol E, Alvarado-Arenas M. et al. Selective elimination diet based on skin testing has suboptimal efficacy for adult eosinophilic esophagitis. J Allergy Clin Immunol 2012; 130: 1200-1202
71 Spergel JM, Brown-Whitehorn TF, Cianferoni A. et al. Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. J Allergy Clin Immunol 2012; 130: 461-467
72 Clayton F, Fang JC, Gleich GJ. et al. Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE. Gastroenterology 2014; 147: 602-609
73 Simon D, Cianferoni A, Spergel JM. et al. Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity. Allergy 2016; 71: 611-62
74 Gonsalves N, Yang GY, Doerfler B. et al. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology 2012; 142: 1451-1455
75 Lucendo AJ, Arias A, Gonzalez-Cervera J. et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease. J Allergy Clin Immunol 2013; 131: 797-804
76 Arias A, González-Cervera J, Tenias JM. et al. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology 2014; 146: 1639-1648
77 Molina-Infante J, Arias A, Barrio J. et al. Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study. J Allergy Clin Immunol 2014; 134: 1093-1099
78 Molina-Infante J, Modolell I, Alcedo J. et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2–4–6 study. United European Gastroenterolgy Week (UEGW). 2016 (abstract)
79 Lucendo AJ, Arias Á, Molina-Infante J. Efficacy of Proton Pump Inhibitor Drugs for Inducing Clinical and Histologic Remission in Patients With Symptomatic Esophageal Eosinophilia: A Systematic Review and Meta-Analysis. Clin Gastroenterol Hepatol 2016; 14: 13-22
80 Gutierrez-Junquera C, Fernandez-Fernandez S, Cilleruelo ML. et al. High revalence of response to proton-pump inhibitor treatment in children with esophageal eosinophilia. J Pediatr Gastroenterol Nutr 2016; 62: 704-710
81 Molina-Infante J, Rodriguez-Sanchez J, Martinek J. et al. Long-term loss of response in proton pump inhibitor-responsive esophageal eosinophilia is uncommon and influenced by CYP2C19 genotype and rhinoconjunctivitis. Am J Gastroenterol 2015; 110: 1567-1575
82 Gomez-Torrijos E, Garcia-Rodriguez R, Castro-Jimenez A. et al. The efficacy of step-down therapy in adult patients with proton pump inhibitorresponsive oesophageal eosinophilia. Aliment Pharmacol Ther 2016; 43: 534-540
83 Konikoff MR, Noel RJ, Blanchard C. et al. A randomized, double-blind, placebo- controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology 2006; 131: 1381-1391
84 Straumann A, Conus S, Degen L. et al. Budesonide is effective in adolescent and adult patients with active eosinophilic esophagitis. Gastroenterology 2010; 139: 1526-1537
85 Dohil R, Newbury R, Fox L. et al. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Gastroenterology 2010; 139: 418-429
86 Alexander JA, Jung KW, Arora AS. et al. Swallowed fluticasone improves histologic but not symptomatic response of adults with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2012; 10: 742-749
87 Butz BK, Wen T, Gleich GJ. et al. Efficacy, dose reduction, and resistance to high-dose fluticasone in patients with eosinophilic esophagitis. Gastroenterology 2014; 147: 324-333
88 Gupta SK, Vitanza JM, Collins MH. Efficacy and safety of oral budesonide suspension in pediatric patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2015; 13: 66-76
89 Miehlke S, Hruz P, Vieth M. et al. A randomised, double-blind trial comparing budesonide formulations and dosages for short-term treatment of eosinophilic oesophagitis. Gut 2016; 65: 390-399
90 Dellon ES, Katzka DA, Collins MH. et al. Budesonide Oral Suspension Improves Symptomatic, Endoscopic, and Histologic Parameters Compared With Placebo in Patients With Eosinophilic Esophagitis. Gastroenterology 2017; 152: 776-786
91 Lucendo AJ, Miehlke S, Vieth M. et al. A randomized, double-blind, placebo-controlled, pivotal multicenter trial with budesonide orodispersible tablets for treatment of active eosinophilic esophagitis (eos-1). Digestive Disease Week (DDW). 2017 (abstract)
92 Tan NDi, Xiao YL, Chen MH. Steroids therapy for eosinophilic esophagitis: Systematic review and meta-analysis. J Dig Dis 2015; 16: 431-442
93 Sawas T, Dhalla S, Sayyar M. et al. Systematic review with meta-analysis: pharmacological interventions for eosinophilic oesophagitis. Aliment Pharmacol Ther 2015; 41: 797-806
94 Murali AR, Gupta A, Attar BM. et al. Topical steroids in eosinophilic esophagitis: systematic review and meta-analysis of placebo controlled randomized clinical trials. J Gastroenterol Hepatol 2015; 31: 1111-1119
95 Dellon ES, Sheikh A, Speck O. et al. Viscous topical is more effective than nebulized steroid therapy for patients with eosinophilic esophagitis. Gastroenterology 2012; 143: 321-324
96 Straumann A, Conus S, Degen L. et al. Long-term budesonide maintenance treatment is partially effective for patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2011; 9: 400-409
97 Kuchen T, Straumann A, Safroneeva E. et al. Swallowed topical corticosteroids reduce the risk for long-lasting bolus impactions in eosinophilic esophagitis. Allergy 2014; 69: 1248-1254
98 Miehlke S, Wohlmuth P, Madisch A. et al. Efficacy of Topical Steroids in Eosinophilic Esophagitis: a metaanalysis. United European Gastroenterology Week (UEGW). 2016 (abstract)
99 Schaefer ET, Fitzgerald JF, Molleston JP. et al. Comparison of Oral Prednisone and Topical Fluticasone in the Treatment of Eosinophilic Esophagitis: A Randomized Trial in Children. Clin Gastroenterol Hepatol 2008; 6: 165-173
100 Netzer P, Gschossmann JM, Straumann A. et al. Corticosteroid-dependent eosinophilic oesophagitis: azathioprine and 6-mercaptopurine can induce and maintain long-term remission. Eur J Gastroenterol Hepatol 2007; 19: 865-869
101 Arias A, Lucendo AJ, Martinez-Fernandez P. et al. Dietary treatment modulates mast cell phenotype, density, and activity in adult eosinophilic oesophagitis. Clin Exp Allergy 2016; 46: 78-91
102 Abonia JP, Blanchard C, Butz BB. et al. Involvement of mast cells in eosinophilic esophagitis. J Allergy Clin Immunol 2010; 126: 140-149
103 Attwood SEA, Lewis CJ, Bronder CS. et al. Eosinophilic oesophagitis: a novel treatment using Montelukast. Gut 2003; 52: 181-185
104 Stumphy J, Al-Zubeidi D, Guerin L. et al. Observations on use of montelukast in pediatric eosinophilic esophagitis: insights for the future. Dis Esophagus 2011; 24: 229-234
105 Alexander JA, Ravi K, Enders FT. et al. Montelukast does not maintain symptom reductions following topical steroid therapy for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2017; 15: 214-222
106 Lucendo AJ, De Rezende LC, Jimenez-Contreras S. et al. Montelukast was inefficient in maintaining steroid-induced remission in adult eosinophilic esophagitis. Dig Dis Sci 2011; 56: 3551-3558
107 Straumann A, Hoesli S, Bussmann C. et al. Anti-eosinophil activity and clinical efficacy of the CRTH2 antagonist OC000459 in eosinophilic esophagitis. Allergy 2013; 68: 375-385
108 Straumann A, Conus S, Grzonka P. et al. Anti-interleukin-5 antibody treatment (mepolizumab) in active eosinophilic oesophagitis: a randomised, placebo- controlled, double-blind trial. Gut 2010; 59: 21-30
109 Assa’ad AH, Gupta SK, Collins MH. et al. An antibody against IL-5 reduces numbers of esophageal intraepithelial eosinophils in children with eosinophilic esophagitis. Gastroenterology 2011; 141: 1593-1604
110 Spergel JM, Rothenberg ME, Collins MH. et al. Reslizumab in children and adolescents with eosinophilic esophagitis: results of a doubleblind, randomized. J Allergy Clin Immunol 2012; 129: 456-463
111 Rothenberg ME, Wen T, Greenberg A. et al. Intravenous anti-IL-13 mAb QAX576 for the treatment of eosinophilic esophagitis. J Allergy Clin Immunol 2015; 135: 500-507
112 Clayton F, Fang JC, Gleich GJ. et al. Eosinophilic esophagitis in adults is associated with IgG4 and not mediated by IgE. Gastroenterology 2014; 147: 602-609
113 Straumann A, Bussmann C, Conus S. et al. Anti-TNF-alpha (infliximab) therapy for severe adult eosinophilic esophagitis. J Allergy Clin Immunol 2008; 122: 425-427
114 Moawad FJ, Cheatham JG, DeZee KJ. Meta-analysis: the safety and efficacy of dilation in eosinophilic oesophagitis. Aliment Pharmacol Ther 2013; 38: 713-720
115 Dougherty M, Runge TM, Eluri S. et al. Esophageal dilation with either bougie or balloon technique as a treatment for eosinophilic esophagitis: a systematic review and meta-analysis. Gastrointest Endosc. 2017 doi:S0016–5107(17)31831-X