LETTER FROM THE EDITOR

Diagnosing and Treating Eosinophilic Esophagitis

osinophilic esophagitis, a chronic inflamma- In our Advances in IBS column, Dr Michael tory disorder of the esophagus characterized by Camilleri examines medical treatments for patients with an esophageal eosinophilic infiltrate and other irritable bowel syndrome. Among other issues, he dis- Eesophageal symptoms, is increasing in prevalence world- cusses the therapeutic agents currently available to treat wide. This disorder is also one of the most common this condition, why new therapies are still needed, the causes of dysphagia and food impactions globally. In a various agents presently being investigated, trial data on feature article in this month’s issue of Gastroenterology safety and adverse effects, the role of bile acids, and chal- & Hepatology, Dr Anna M. Lipowska and Dr Robert T. lenges associated with drug development. Kavitt explore the diagnostic and treatment strategies Therapeutic drug monitoring of inflammatory currently available for this condition. The authors discuss bowel disease patients taking biologic therapy is the endoscopic and histologic evaluation, the role of proton focus of our Advances in IBD column. Dr Adam pump inhibitors, and the use of other diagnostic tools, Cheifetz discusses why therapeutic drug monitoring as well as dietary therapies (including elemental diet, is important in this setting, when drug concentrations allergy testing–directed elimination diet, and empiric should be measured, study data on reactive therapeutic elimination diet), topical and systemic corticosteroids, drug monitoring as well as on proactive therapeutic drug endoscopic dilation, and various pharmacologic experi- monitoring, and the challenges associated with these mental therapies. methods, among other issues. Another feature article examines the black box warn- Finally, in our Advances in Hepatology column, Dr ing for potential reactivation of hepatitis B virus during Marcelo Kugelmas examines nonliver-related benefits the use of direct-acting antiviral therapy in patients with associated with obtaining sustained virologic response in chronic hepatitis C virus infection. Dr Paul J. Pockros patients with hepatitis C virus infection. He discusses describes initial and recent reports of hepatitis B virus how, in addition to stopping inflammation and fibrosis, reactivation, the resulting effects on initiating and moni- sustained virologic response can lead to improvements toring treatment (including the recent black box warning in quality of life, diabetes and insulin resistance, cryo- on all direct-acting antiviral drugs and combinations), globulinemia, renal disease, lymphoma risk, cardiovas- and how society guidelines have been updated. cular disease, and cerebrovascular disease. This month’s Advances in Endoscopy column I hope you enjoy these articles and find them clini- focuses on endoscopic sleeve gastroplasty. Dr Reem cally useful. Sharaiha discusses issues such as the procedure’s role in the management of obesity, how it is performed, its Sincerely, effectiveness in the long term, and its associated adverse events. She also describes the ideal candidate and com- pares the procedure to other endoscopic and surgical options for managing obesity. Gary R. Lichtenstein, MD, AGAF, FACP, FACG

522 Gastroenterology & Hepatology Volume 13, Issue 9 September 2017