Table 2.

Research needs in eosinophilic oesophagitis

Area	Research need	Example
Natural history	Better understanding of onset of disease and natural history of EoE in both treated and untreated individuals	Long-term follow-up data in treated patients
Cause of EoE	Understand better the pathophysiological mechanisms underlying cause of disease	Better understanding of genetic predisposition and disease triggers
Clinical presentation	Validated symptom questionnaires for disease monitoring	Use of EEsAI and HRQoL
Diagnosis	Clearer definition of histological disease diagnosis	Assess value of mast cell activity, fibroblast activity and density of submucosal fibrosis
	Less invasive methods of disease detection	Cytosponge or string test, transnasal endoscopy
	Potential of systemic biomarkers of disease	Blood messenger RNA levels of CD101 and CD274 expressing eosinophils
	Assessment of the timing and value of stopping a PPI before a diagnostic biopsy	Current advice on 3 weeks gap needs further study
	The relevance of allergy testing in EoE	Value of testing for treatment of symptoms in other organs
Management	Comparisons of therapeutic strategies and which one to use as first line options	Using standardised symptom questionnaires to distinguish optimum initial therapy
	Role of novel biologics in the management algorithm	Use of drugs such as dupilimab, benralizumab and cendakimab in both steroid naïve and steroid unresponsive patients
Prevention of EoE	Long-term outcomes of each therapeutic option with comparison of efficacy and side effects	Follow-up data of patients on therapy
Prognosis	The value of achieving deep remission versus remission and threshold levels of their definition	Value of suppressing eosinophil count <5 eosinophils/0.3 mm2 compared with <15 eosinophils/0.3 mm2

EEsAI, Eosinophilic Esophagitis symptom Assessment Index; EoE, eosinophilic oesophagitis; HRQoL, health-related quality of life; PPI, proton pump inhibitor.