Eosinophilic esophagitis (EoE) is a chronic, immune-mediated condition in which eosinophils accumulate in the lining of the esophagus, causing inflammation, swallowing difficulties, food impaction, and esophageal strictures. It is driven largely by food and environmental allergens and has become increasingly recognized over the past two decades, particularly in children and young adults. Untreated, it can cause progressive esophageal remodeling and fibrosis.
What's actually going on in research
Proton pump inhibitors (PPIs), topical swallowed corticosteroids (budesonide or fluticasone), and elimination diets are the established treatment approaches. Dupilumab — an IL-4/IL-13 receptor blocker approved for atopic dermatitis and asthma — is now also approved for EoE and significantly reduces esophageal eosinophil counts and symptoms. Trials are investigating thymic stromal lymphopoietin (TSLP) blockers, anti-IL-5 agents, mast cell-targeted therapies, and dietary trigger identification tools to further personalize care.
Dupilumab and type 2 immunity
Dupilumab is now approved for EoE after demonstrating eosinophil count reduction and swallowing symptom improvement, and next-generation IL-4/IL-13 blockers are entering trials.
TSLP and upstream allergy pathway
Tezepelumab (anti-TSLP) and other upstream allergy pathway inhibitors are in EoE trials given the role of epithelial alarmins in driving esophageal eosinophilic inflammation.
Mast cell targeting
Mast cells contribute to esophageal symptoms and remodeling in EoE, and anti-KIT and siglec-8 antibodies targeting mast cells are in early trials for patients with inadequate biologic response.
What to know before you search
Eligibility typically requires biopsy-confirmed EoE with ≥15 eosinophils per high-power field and active swallowing symptoms.
What types of trials are currently open
- Biologic therapy trials — Testing dupilumab, anti-IL-5, anti-TSLP, and mast cell-directed biologics in active EoE.
- Topical corticosteroid trials — Evaluating optimized budesonide orodispersible tablet formulations and dosing for EoE remission.
- Food trigger trials — Studying elimination diet protocols and IgE-directed food allergy diagnostics to guide dietary management.
- Fibrosis and remodeling studies — Assessing how early treatment affects esophageal wall remodeling and stricture formation over time.
- Pediatric EoE trials — Evaluating biologics and dietary interventions specifically in children with EoE.
Recently added Eosinophilic Esophagitis trials
Natural History of Eosinophilic Esophagitis in Adult and Pediatric Population
Eosinophilic esophagitis (EoE) is a Th2-mediated disease induced by ingestion of ambiental and alimentary allergens. Incidence of EoE is increasing in recent years. Young male subjects are more often affected by EoE. Esophageal eosinophilic infiltrate causes different symptoms of esophageal dysfunction (i.e. dysphagia, food impaction, chest pain, heartburn). In pediatric population symptoms are nonspecific (failure to thrive, vomiting) and more common to be misdiagnosed. Symptoms are commonly sporadic and underestimated by the patients. Therefore, specialistic evaluations are often delayed during the following months and years. Moreover, esophageal symptoms are often not investigated or associated with other diseases especially in pediatric population (i.e. gastroesophageal reflux disease). For this reason, diagnosis of EoE is often delayed. It is known from literature that diagnostic delay in EoE causes prolonged inflammation of the esophagus that may lead to esophageal fibrosis and stenosis with worsening of symptoms. Proton pump inhibitors (PPIs) and topical steroids are the first line medicines to induce EoE remission. Prolonged clinical remission is described in 60% of adult patients with PPIs. Recently orodispersible budesonide showed clinical remission after 1 year nearby in 90% of adult patients. Orodispersible budesonide is effective also in chidren with an efficacy in maintaining remission at lowest effective dosage after 60 weeks in around 78% of patients. Dysphagia Symptom Questionnaire (DSQ) is a validated tool used in order to measure clinical activity (dysphagia) in adult and pediatric patients with EoE. Italian version of the DSQ is not available in literature. Little is known in literature about the natural history of EoE patients, in particular about sustained clinical remission and appearance of complications (i.e. food impaction) during a prolonged follow-up period. Aim of our two-phase prospective study is to evaluate the clinical and endoscopic response at the current available therapies and the appearance of complications during a prolonged follow-up period in a cohort of adult and pediatric population.
Share your esophageal health data in a long-term registry
Digestive physiopathology is a branch of gastroenterology aiming to study patients with upper GI symptoms, mainly gastro-esophageal, potentially indicating the presence of Gastroesophageal Reflux Disease (GERD)/Barrett Esophagus (BE) or obstructive esophageal motility disorders (achalasia being the most relevant), but including also other primary motility disorders such as Esophgago-Gastric Junction Outflow Obstruction (EGJOO), Hypercontractile Esophagus (HE), Distal Esophageal Spasm (DES) and other minor disorders. Physiopathological testing encompasses High-Resolution Manometry (HRM), 24-H esophageal pH-impedance testing, Functional Lumen Imaging Probe (FLIP) assessment. All these tests are designed to provide a clear phenotyping of esophago-gastric disorders related to reflux or obstructive esophageal symptoms, either in naïve patients, as well as after foregut surgery (particularly anti-reflux surgery, achalasia/primary motility disorders treatment).
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