Update on the therapeutic management of eosinophilic esophagitis in adults
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Publicación 8. Vol 6. Num 3.1 (Español (España))
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Published:
Aug 30, 2023
Keywords:
Adults, eosinophilic, esophagitis, histopathology, molecular, symptomatology, treatment.
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Abstract
Introduction: In recent years, eosinophilic esophagitis has emerged as one of the main causes of chronic gastrointestinal morbidity. Despite its low prevalence, there has been a steady increase in incidence, secondary to new lifestyle changes. Currently, there are established treatment protocols, hence it's crucial to be aware of the latest updates for the well-being of patients. Methodology: This is a narrative bibliographic review study, a broad literature review, about the update in the therapeutic management of eosinophilic esophagitis in adults, such as Pub Med, Scielo, Cochrane Library, and Science Direct, as part of the PRISMA strategy. Results: 57 studies were reviewed, which compiled the main recommendations on the update in the therapeutic management of eosinophilic esophagitis in adults. Conclusions: Eosinophilic esophagitis is a chronic disease secondary to an immune dysregulation process, whose incidence is increasing and its management should be comprehensive and be made up of pathologists, allergists, and nutrition specialists. This should be suspected in any patient with symptoms of refractory GERD or with dysphagia to solids or liquids, especially in young atopic males, besides clinical suspicion alone is an indication for a prompt endoscopic study and biopsy, even in a patient with a normal-looking esophagus.
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Barzallo Córdova, M. J., & Orellana Bernal, P. V. (2023). Update on the therapeutic management of eosinophilic esophagitis in adults. ConcienciaDigital, 6(3.1), 142-178. https://doi.org/10.33262/concienciadigital.v6i3.1.2663
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References
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Ballart, M. (2020). Esofagitis eosinofílica: diagnóstico y manejo. Rev Med Chil. https://doi.org/10.4067/S0034-98872020000600831
Castro, A. (2018). Esofagitis eosinofílica: consideraciones fisiopatológicas y terapéuticas. https://doi.org/10.20960/nh.2046
Cessa-Zanatta, J. (2023). Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients. Gastroenterol Hepatol. https://doi.org/10.1016/j.gastrohep.2023.03.002
Chehade, M. (2021). Treatment of Eosinophilic Esophagitis: Diet or Medication? J Allergy Clin Immunol Pract.
Cianferoni, A. (2021). The Role of the Environment in Eosinophilic Esophagitis. J Allergy Clin Immunol Pract.
Cotton, C., Woosley, J., Moist, S., McGee, S., Iuga, A., Shaheen , N., y Dellon, E. (2022). Determination of a treatment response threshold for the Eosinophilic Esophagitis Endoscopic Reference Score. Endoscopy, 54(7). https://doi.org/10.1055/a-1675-7860
Dellon, E. (2019). A Novel Allergen-Specific Immune Signature-Directed Approach to Dietary Elimination in Eosinophilic Esophagitis. Clin Transl Gastroenterol.
Dellon, E. (2022). A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology.
Dellon, E., Collins, M., Katzka, D., y Mukkada, V. (2022). ORBIT2/SHP621-302 Investigators. Long-Term Treatment of Eosinophilic Esophagitis With Budesonide Oral Suspension. Clin Gastroenterol Hepatol, 20(7). https://doi.org/10.1016/j.cgh.2021.06.020
Dellon, E., Khoury, P., Muir, A., Liacouras, C., Safroneeva, E., Atkins, D., . . . Falk, G. (2022). A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology, 163(1). https://doi.org/10.1053/j.gastro.2022.03.025
Dellon, E., Rothenberg, M., Collins, M., Hirano, I., Chehade, M., Bredenoord, A., . . . Spergel, J. (2022). Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med, 387(25). https://doi.org/10.1056/NEJMoa2205982
Dellon, E., Woosley, J., Arrington, A., McGee, S., Covington, J., Moist, S., y Gebhart, J. (2019). Efficacy of Budesonide vs Fluticasone for Initial Treatment of Eosinophilic Esophagitis in a Randomized Controlled Trial. Gastroenterology, 157(1). https://doi.org/10.1053/j.gastro.2019.03.014
Eluri, S., Selitsky, S., Perjar, I., y Hollyfield, J. (2019). Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol, 17(6). https://doi.org/10.1016/j.cgh.2018.09.005
García, F. (2020). Esofagitis eosinofílica y esofagitis infecciosas y tóxicas. Medicine. https://doi.org/http://dx.doi.org/10.1016/j.med.2020.05.003
García-Martíne, D. (2020). Transcultural adaptation of the Pediatric Eosinophilic Esophagitis Quality of Life Module Questionnaire. https://doi.org/10.1016/j.anpedi.2020.01.005
Godwin, B. (2020). EoE disease monitoring. Ann Allergy Asthma Immunol.
Gutiérrez, E. (2020). Recommendations for the diagnosis and practical management of paediatric eosinophilic oesophagitis. https://doi.org/10.1016/j.anpedi.2020.04.007
Hao, L. (2021). Meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome. Gastroenterol Hepatol. https://doi.org/10.1016/j.gastrohep.2020.07.010
Hara, T. (2022). CD73+ Epithelial Progenitor Cells That Contribute to Homeostasis and Renewal Are Depleted in Eosinophilic Esophagitis. Cell Mol Gastroenterol Hepatol.
Hirano, I. (2019). RPC4046, a Monoclonal Antibody Against IL13, Reduces Histologic and Endoscopic Activity in Patients With Eosinophilic Esophagitis. Gastroenterology.
Hirano, I. (2020). AK002, an anti-siglec-8 antibody, depletes tissue eosinophils and improves dysphagia symptoms in patients with eosinophilic esophagitis. J Allergy Clin Immunol. https://doi.org/http://dx.doi.org/10.1016/j.jaci.2019.12.343
Jensen, E., Langefeld, C., Zimmerman, K., Howard, T., y Dellon, D. (2020). Epigenetic methylation in Eosinophilic Esophagitis: Molecular ageing and novel biomarkers for treatment response. Clin Exp Allergy, 50(12). https://doi.org/10.1111/cea.13748
Johnson, K. (2019). Poor Relationship Between Fractionated Exhaled Nitric Oxide and Disease Activity in Eosinophilic Esophagitis. Dysphagia.
Junquera, E. (2020). Recomendaciones para el diagnóstico y manejo práctico de la esofagitis eosinofílica pediátrica. Anales de Pediatría, 92(6).
Ketchem, X., Thakkar, K., Xue, A., Reddy, S., y Abramson, L. (2022). Older patients with eosinophilic esophagitis have high treatment response to topical steroids. Dig Liver Dis, 54(4). https://doi.org/10.1016/j.dld.2021.10.004
Kliewer, K., Gonsalves, N., Dellon, E., Katzka, D., Abonia, J., Aceves, S., y Arva, N. (2023). One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol, 8(5). https://doi.org/10.1016/S2468-1253(23)00012-2
Lam, A. (2022). Eosinophilic esophagitis: New molecules, better life? Curr Opin Pharmacol.
Leung, J. (2022). Combination of Proton Pump Inhibitors and Food Elimination Diet for Eosinophilic Esophagitis Refractory to Monotherapy. Gastro Hep Adv.
Lim, A., Wong, S., y Nguyen, N. (2021). Eosinophilic Esophagitis and IgG4: Is There a Relationship? Dig Dis Sci, 66(12). https://doi.org/10.1007/s10620-020-06788-0
Liu, X., Xiao, X., Liu, D., y Tan, C. (2022). A meta-analysis on randomized controlled trials of treating eosinophilic esophagitis with budesonide. Ann Med, 54(1). https://doi.org/10.1080/07853890.2022.2101689
Lucendo, A., Miehlke, S., y Schlag, C. (2019). Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology, 157(1). https://doi.org/10.1053/j.gastro.2019.03.025
Ma, C. (2022). Development of a core outcome set for therapeutic studies in eosinophilic esophagitis (COREOS). J Allergy Clin Immunol.
Madrazo-de la Garza, J. (2019). Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mex. https://doi.org/10.1016/j.rgmx.2019.06.001
Maskey, A., Wang, Z., Chen, X., y Dunkin, D. (2022). Computational analysis to define efficacy & molecular mechanisms of 7, 4'- Dihydroxyflavone on eosinophilic esophagitis: Ex-vivo validation in human esophagus biopsies. Front Immunol. https://doi.org/10.3389/fimmu.2022.1015437
Miret-Salvador, M. (2022). Esofagitis eosinofílica. Un caso clínico no tan raro. Semergen. https://doi.org/10.1016/j.semerg.2021.04.012
Miret-Salvador, M. (2022). Esofagitis eosinofílica. Un caso clínico no tan raro. Semergen. https://doi.org/http://dx.doi.org/10.1016/j.semerg.2021.04.012
Monrroy, M. (2020). Esofagitis eosinofílica: diagnóstico y manejo. Rev. méd. Chile. https://doi.org/http://dx.doi.org/10.4067/S0034-98872020000600831
Muir, A. (2019). Eosinophilic esophagitis: early diagnosis is the key. Clin Exp Gastroenterol.
Muir, A., y Falk, G. (2021). Eosinophilic Esophagitis: A Review. JAMA, 326(13). https://doi.org/10.1001/jama.2021.14920
Nhu, Q., y Aceves, S. (2023). Current state of biologics in treating eosinophilic esophagitis. Ann Allergy Asthma Immunol, 130(1). https://doi.org/10.1016/j.anai.2022.10.004
NosColom, A. (2021). Papiloma esofágico escamoso y esofagitis eosinofílica [Squamous esophageal papilloma and eosinophilic esophagitis]. An Pediatr (Engl Ed). https://doi.org/10.1016/j.anpedi.2021.06.002
Okimoto, E., Ishimura, N., y Ishihara, S. (102 de 2021). Clinical Characteristics and Treatment Outcomes of Patients with Eosinophilic Esophagitis and Eosinophilic Gastroenteritis. Digestion, 1. https://doi.org/10.1159/000511588
Oliva, S., Dias, J., Rea, F., Malamisura, M., Espinheira, M., Papadopoulou, A., . . . Rossetti, D. (2022). haracterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN. J Pediatr Gastroenterol Nutr, 75(3). https://doi.org/10.1097/MPG.0000000000003530
Pérez-Martínez, I. (2019). Eosinophilic esophagitis: An evidenced-based approach to diagnosis and treatment. Med Clin (Barc). https://doi.org/10.1016/j.medcli.2018.10.022
Pérez-Martínez, I. (2019). Esofagitis eosinofílica: aproximación al diagnóstico y tratamiento desde la evidencia. Med Clin (Barc). https://doi.org/http://dx.doi.org/10.1016/j.medcli.2018.10.022
Pierre, R. (2019). Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mex. https://doi.org/10.1016/j.rgmx.2018.08.001
Rojas, M. (2020). Throat clearing as the only symptom of eosinophilic esophagitis: A case report. Rev Gastroenterol Mex. https://doi.org/10.1016/j.rgmx.2019.04.003
Rothenberg, M. (2022). Scientific journey to the first FDA-approved drug for eosinophilic esophagitis. J Allergy Clin Immunol.
Serrano, V. (2022). Pseudodiverticulosis y esofagitis eosinofílica: un hallazgo infrecuente Pseudodiverticulosis and eosinophilic esophagitis: An infrequent finding]. An Pediatr (Engl Ed). https://doi.org/10.1016/j.anpedi.2021.05.009
Silva, F. (2020). Disodium cromoglycate treatment reduces TH2 immune response and immunohistopathological features in a murine model of Eosinophilic Esophagitis. Int Immunopharmacol.
Straumann, A., Lucendo, A., Miehlke, S., Vieth, M., Schlag, C., Biedermann, L., y Vaquero, C. (2020). Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis. Gastroenterology, 159(5). https://doi.org/10.1053/j.gastro.2020.07.039
Strossman, N. (2022). xploring Treatment Options for Eosinophilic Esophagitis. Gastroenterol Insights.
Teramoto-Matsubara, O. (2019). Acute dysphagia presentation and its association with esophagitis dissecans and concomitant diseases. A diagnostic challenge. https://doi.org/10.24875/CIRU.18000607
Umaña, C. (2020). Esofagitis eosinofílica. Rev.méd.sinerg. https://www.revistamedicasinergia.com/index.php/rms/article/view/359
Underwood, B. (2023). Breaking down the complex pathophysiology of eosinophilic esophagitis. Ann Allergy Asthma Immunol.
Yasuda, T. (2021). Endoscopic Characteristics in Eosinophilic Esophagitis Patients. Tech Innov Gastrointest Endosc.
Ballart, M. (2020). Esofagitis eosinofílica: diagnóstico y manejo. Rev Med Chil. https://doi.org/10.4067/S0034-98872020000600831
Castro, A. (2018). Esofagitis eosinofílica: consideraciones fisiopatológicas y terapéuticas. https://doi.org/10.20960/nh.2046
Cessa-Zanatta, J. (2023). Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients. Gastroenterol Hepatol. https://doi.org/10.1016/j.gastrohep.2023.03.002
Chehade, M. (2021). Treatment of Eosinophilic Esophagitis: Diet or Medication? J Allergy Clin Immunol Pract.
Cianferoni, A. (2021). The Role of the Environment in Eosinophilic Esophagitis. J Allergy Clin Immunol Pract.
Cotton, C., Woosley, J., Moist, S., McGee, S., Iuga, A., Shaheen , N., y Dellon, E. (2022). Determination of a treatment response threshold for the Eosinophilic Esophagitis Endoscopic Reference Score. Endoscopy, 54(7). https://doi.org/10.1055/a-1675-7860
Dellon, E. (2019). A Novel Allergen-Specific Immune Signature-Directed Approach to Dietary Elimination in Eosinophilic Esophagitis. Clin Transl Gastroenterol.
Dellon, E. (2022). A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology.
Dellon, E., Collins, M., Katzka, D., y Mukkada, V. (2022). ORBIT2/SHP621-302 Investigators. Long-Term Treatment of Eosinophilic Esophagitis With Budesonide Oral Suspension. Clin Gastroenterol Hepatol, 20(7). https://doi.org/10.1016/j.cgh.2021.06.020
Dellon, E., Khoury, P., Muir, A., Liacouras, C., Safroneeva, E., Atkins, D., . . . Falk, G. (2022). A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. Gastroenterology, 163(1). https://doi.org/10.1053/j.gastro.2022.03.025
Dellon, E., Rothenberg, M., Collins, M., Hirano, I., Chehade, M., Bredenoord, A., . . . Spergel, J. (2022). Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med, 387(25). https://doi.org/10.1056/NEJMoa2205982
Dellon, E., Woosley, J., Arrington, A., McGee, S., Covington, J., Moist, S., y Gebhart, J. (2019). Efficacy of Budesonide vs Fluticasone for Initial Treatment of Eosinophilic Esophagitis in a Randomized Controlled Trial. Gastroenterology, 157(1). https://doi.org/10.1053/j.gastro.2019.03.014
Eluri, S., Selitsky, S., Perjar, I., y Hollyfield, J. (2019). Clinical and Molecular Factors Associated With Histologic Response to Topical Steroid Treatment in Patients With Eosinophilic Esophagitis. Clin Gastroenterol Hepatol, 17(6). https://doi.org/10.1016/j.cgh.2018.09.005
García, F. (2020). Esofagitis eosinofílica y esofagitis infecciosas y tóxicas. Medicine. https://doi.org/http://dx.doi.org/10.1016/j.med.2020.05.003
García-Martíne, D. (2020). Transcultural adaptation of the Pediatric Eosinophilic Esophagitis Quality of Life Module Questionnaire. https://doi.org/10.1016/j.anpedi.2020.01.005
Godwin, B. (2020). EoE disease monitoring. Ann Allergy Asthma Immunol.
Gutiérrez, E. (2020). Recommendations for the diagnosis and practical management of paediatric eosinophilic oesophagitis. https://doi.org/10.1016/j.anpedi.2020.04.007
Hao, L. (2021). Meta-analysis of efficacy of topical steroids in eosinophilic esophagitis: From the perspective of histologic, clinical, and endoscopic outcome. Gastroenterol Hepatol. https://doi.org/10.1016/j.gastrohep.2020.07.010
Hara, T. (2022). CD73+ Epithelial Progenitor Cells That Contribute to Homeostasis and Renewal Are Depleted in Eosinophilic Esophagitis. Cell Mol Gastroenterol Hepatol.
Hirano, I. (2019). RPC4046, a Monoclonal Antibody Against IL13, Reduces Histologic and Endoscopic Activity in Patients With Eosinophilic Esophagitis. Gastroenterology.
Hirano, I. (2020). AK002, an anti-siglec-8 antibody, depletes tissue eosinophils and improves dysphagia symptoms in patients with eosinophilic esophagitis. J Allergy Clin Immunol. https://doi.org/http://dx.doi.org/10.1016/j.jaci.2019.12.343
Jensen, E., Langefeld, C., Zimmerman, K., Howard, T., y Dellon, D. (2020). Epigenetic methylation in Eosinophilic Esophagitis: Molecular ageing and novel biomarkers for treatment response. Clin Exp Allergy, 50(12). https://doi.org/10.1111/cea.13748
Johnson, K. (2019). Poor Relationship Between Fractionated Exhaled Nitric Oxide and Disease Activity in Eosinophilic Esophagitis. Dysphagia.
Junquera, E. (2020). Recomendaciones para el diagnóstico y manejo práctico de la esofagitis eosinofílica pediátrica. Anales de Pediatría, 92(6).
Ketchem, X., Thakkar, K., Xue, A., Reddy, S., y Abramson, L. (2022). Older patients with eosinophilic esophagitis have high treatment response to topical steroids. Dig Liver Dis, 54(4). https://doi.org/10.1016/j.dld.2021.10.004
Kliewer, K., Gonsalves, N., Dellon, E., Katzka, D., Abonia, J., Aceves, S., y Arva, N. (2023). One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol, 8(5). https://doi.org/10.1016/S2468-1253(23)00012-2
Lam, A. (2022). Eosinophilic esophagitis: New molecules, better life? Curr Opin Pharmacol.
Leung, J. (2022). Combination of Proton Pump Inhibitors and Food Elimination Diet for Eosinophilic Esophagitis Refractory to Monotherapy. Gastro Hep Adv.
Lim, A., Wong, S., y Nguyen, N. (2021). Eosinophilic Esophagitis and IgG4: Is There a Relationship? Dig Dis Sci, 66(12). https://doi.org/10.1007/s10620-020-06788-0
Liu, X., Xiao, X., Liu, D., y Tan, C. (2022). A meta-analysis on randomized controlled trials of treating eosinophilic esophagitis with budesonide. Ann Med, 54(1). https://doi.org/10.1080/07853890.2022.2101689
Lucendo, A., Miehlke, S., y Schlag, C. (2019). Efficacy of Budesonide Orodispersible Tablets as Induction Therapy for Eosinophilic Esophagitis in a Randomized Placebo-Controlled Trial. Gastroenterology, 157(1). https://doi.org/10.1053/j.gastro.2019.03.025
Ma, C. (2022). Development of a core outcome set for therapeutic studies in eosinophilic esophagitis (COREOS). J Allergy Clin Immunol.
Madrazo-de la Garza, J. (2019). Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mex. https://doi.org/10.1016/j.rgmx.2019.06.001
Maskey, A., Wang, Z., Chen, X., y Dunkin, D. (2022). Computational analysis to define efficacy & molecular mechanisms of 7, 4'- Dihydroxyflavone on eosinophilic esophagitis: Ex-vivo validation in human esophagus biopsies. Front Immunol. https://doi.org/10.3389/fimmu.2022.1015437
Miret-Salvador, M. (2022). Esofagitis eosinofílica. Un caso clínico no tan raro. Semergen. https://doi.org/10.1016/j.semerg.2021.04.012
Miret-Salvador, M. (2022). Esofagitis eosinofílica. Un caso clínico no tan raro. Semergen. https://doi.org/http://dx.doi.org/10.1016/j.semerg.2021.04.012
Monrroy, M. (2020). Esofagitis eosinofílica: diagnóstico y manejo. Rev. méd. Chile. https://doi.org/http://dx.doi.org/10.4067/S0034-98872020000600831
Muir, A. (2019). Eosinophilic esophagitis: early diagnosis is the key. Clin Exp Gastroenterol.
Muir, A., y Falk, G. (2021). Eosinophilic Esophagitis: A Review. JAMA, 326(13). https://doi.org/10.1001/jama.2021.14920
Nhu, Q., y Aceves, S. (2023). Current state of biologics in treating eosinophilic esophagitis. Ann Allergy Asthma Immunol, 130(1). https://doi.org/10.1016/j.anai.2022.10.004
NosColom, A. (2021). Papiloma esofágico escamoso y esofagitis eosinofílica [Squamous esophageal papilloma and eosinophilic esophagitis]. An Pediatr (Engl Ed). https://doi.org/10.1016/j.anpedi.2021.06.002
Okimoto, E., Ishimura, N., y Ishihara, S. (102 de 2021). Clinical Characteristics and Treatment Outcomes of Patients with Eosinophilic Esophagitis and Eosinophilic Gastroenteritis. Digestion, 1. https://doi.org/10.1159/000511588
Oliva, S., Dias, J., Rea, F., Malamisura, M., Espinheira, M., Papadopoulou, A., . . . Rossetti, D. (2022). haracterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN. J Pediatr Gastroenterol Nutr, 75(3). https://doi.org/10.1097/MPG.0000000000003530
Pérez-Martínez, I. (2019). Eosinophilic esophagitis: An evidenced-based approach to diagnosis and treatment. Med Clin (Barc). https://doi.org/10.1016/j.medcli.2018.10.022
Pérez-Martínez, I. (2019). Esofagitis eosinofílica: aproximación al diagnóstico y tratamiento desde la evidencia. Med Clin (Barc). https://doi.org/http://dx.doi.org/10.1016/j.medcli.2018.10.022
Pierre, R. (2019). Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mex. https://doi.org/10.1016/j.rgmx.2018.08.001
Rojas, M. (2020). Throat clearing as the only symptom of eosinophilic esophagitis: A case report. Rev Gastroenterol Mex. https://doi.org/10.1016/j.rgmx.2019.04.003
Rothenberg, M. (2022). Scientific journey to the first FDA-approved drug for eosinophilic esophagitis. J Allergy Clin Immunol.
Serrano, V. (2022). Pseudodiverticulosis y esofagitis eosinofílica: un hallazgo infrecuente Pseudodiverticulosis and eosinophilic esophagitis: An infrequent finding]. An Pediatr (Engl Ed). https://doi.org/10.1016/j.anpedi.2021.05.009
Silva, F. (2020). Disodium cromoglycate treatment reduces TH2 immune response and immunohistopathological features in a murine model of Eosinophilic Esophagitis. Int Immunopharmacol.
Straumann, A., Lucendo, A., Miehlke, S., Vieth, M., Schlag, C., Biedermann, L., y Vaquero, C. (2020). Budesonide Orodispersible Tablets Maintain Remission in a Randomized, Placebo-Controlled Trial of Patients With Eosinophilic Esophagitis. Gastroenterology, 159(5). https://doi.org/10.1053/j.gastro.2020.07.039
Strossman, N. (2022). xploring Treatment Options for Eosinophilic Esophagitis. Gastroenterol Insights.
Teramoto-Matsubara, O. (2019). Acute dysphagia presentation and its association with esophagitis dissecans and concomitant diseases. A diagnostic challenge. https://doi.org/10.24875/CIRU.18000607
Umaña, C. (2020). Esofagitis eosinofílica. Rev.méd.sinerg. https://www.revistamedicasinergia.com/index.php/rms/article/view/359
Underwood, B. (2023). Breaking down the complex pathophysiology of eosinophilic esophagitis. Ann Allergy Asthma Immunol.
Yasuda, T. (2021). Endoscopic Characteristics in Eosinophilic Esophagitis Patients. Tech Innov Gastrointest Endosc.