| The recognition of eosinophilic gastrointestinal disease (EGIDs) continues to increase globally over the past 3 decades. Comparisons between the epidemiology and phenotypes of EGIDs between the US and Japan may provide important insights into disease pathogenesis. The current management of eosinophilic esophagitis (EoE) continues to rely upon use of proton pump inhibition, swallowed topical corticosteroids and elimination diet therapy. Recent studies have shown that less restricted, empiric elimination diets (i.e. elimination of only dairy or dairy and wheat) are an effective alternative to a full six food elimination diet (avoidance of dairy, wheat, soy, egg, nuts, seafood). The recent FDA and EMA approval of dupilumab for EoE, a monoclonal antibody for the IL-4Ra, offers a highly effective alternative treatment option. Several immunomodulators and biologics are in active clinical trials for both EoE and EGIDs. These trials have also identified a fundamental limitations of targeted therapeutics directed primarily at the eosinophil. These trials have also demonstrated a concern with the reliance on esophageal eosinophil density (peak eosinophil count) in biopsies as a reliable endpoint to define successful therapy of EoE and EGIDs. A treat to target approach to the management of EoE is recommended to optimize disease management. |
