Table 17.

Knowledge and Evidence Gaps in the Management of Eosinophilic Esophagitis

Use of uniform end points among clinical trials to facilitate meaningful comparisons between therapies

Understanding the mechanisms and management of persistent symptoms in spite of histologic remission

Defining the extent and implications of variations in clinical outcomes for individual patients

Head-to-head studies comparing therapies to inform an algorithmic approach

Effectiveness of combinations of treatments (eg, PPI + diet, PPI + steroids, steroids + diet, steroids + dilation)

Prospective data on the natural history of EoE to inform decisions regarding maintenance therapy

Longer-term studies evaluating the efficacy of maintenance medical and diet therapies

Measurement of quality of life and nutritional status as outcomes

Use of biomarkers for diagnosis and monitoring

Validation of office-based, nonendoscopic disease-monitoring methods for EoE activity

Appropriate timing of esophageal dilation in relation to use of medical or diet therapy (eg, should esophageal dilation only be performed after initiation of medical or diet therapy)

Using clinical history of symptoms with food exposure to guide therapy in EoE

Interaction between oral immunotherapy for food allergy and EoE

Impact of other associated atopic diseases (IgE-mediated food allergy, pollen food allergy, atopic dermatitis, asthma, allergic rhinitis)

Effectiveness of environmental allergen avoidance and immunotherapy