There are various therapeutic options available for treating patients with eosinophilic esophagitis (EoE):
- dietary modifications
- proton pump inhibitors (PPI)
- topical corticosteroids
- endoscopic esophageal dilation
Proton pump inhibitors are currently considered the first-line treatment for eosinophilic esophagitis, achieving histological remission and improvement of symptoms in 50.5% and 60.8% of patients, respectively.
Regarding topical corticosteroids in eosinophilic esophagitis, budesonide and fluticasone propionate both decrease eosinophil densities in the esophageal mucosa and relieve symptoms. However, owing to differences in drug delivery, viscous budesonide seems to be the best pharmacological therapy for eosinophilic esophagitis.
Results for dietary modifications have been mixed depending on the type of diet prescribed:
- amino acid-based elemental diets are the most effective in inducing histological remission of eosinophilic esophagitis (90.8% but they have drawbacks limiting implementation in clinical practice
- allergy testing-based food elimination provides a suboptimal remission rate of 45.5%, although this is lower in adults than in children (32.2% vs 47.9%, respectively)
- empirical 6-food elimination diets were shown to be the best diet-based therapy, with a remission rate of 72%
Eosinophilic Esophagitis (click here to enlarge the image).
Eosinophilic Esophagitis: An Evidence-Based Approach to Therapy. González-Cervera J, Lucendo AJ. J Investig Allergol Clin Immunol. 2016;26(1):8-18; quiz 2p following 18.
Image source: Eosinophilic esophagitis, Wikipedia, GNU Free Documentation License.