The role of biologics in the pathogenesis and treatment of eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterized by inflammation, and intraepithelial infiltration of eosinophils in the esophageal epithelium. It associated with unbearable symptoms, such as dysphagia, bolus impaction which affect nutritional status, quality life patients. diagnosed from thorough medical history, confirmed endoscopy biopsy. Traditionally, it has been treated elimination diet, proton pump inhibitors, swallowed topical corticosteroids. However, several patients EoE are refractory to treatment. like eosinophilic asthma T helper type 2 lymphocyte (Th2)-mediated allergic disease. During an inflammation Th2 cells secrete cytokines, interleukin-5 (IL-5). IL-4, IL-13 play key role pathogenesis EoE. cytokines promote eosinophilopoiesis, differentiation, proliferation, maturation activation eosinophils. Activated liberate cytotoxic cationic proteins, reactive oxygen species cause epithelial injury, remodeling, later progresses fibrosis. Dupilumab (dupixent®)is monoclonal antibody target IL-4 receptor (IL-4Rα) signals for both IL-13. only biologic effective, approved treatment adults children 12 years older. Treatment dupixent® shown improve dilate relax gullet, allow enjoy their cherished dish. Biologics dupilumab should be administered early order prevent menacing complications disease, stricture, perforation, necessitate surgical dilatation, repair.