From the Guidelines
I strongly recommend that you seek immediate medical attention for your swallowing difficulties related to eosinophilic esophagitis (EOE) and consider esophageal dilation as a treatment option, as suggested by the AGA/JTF guidelines 1. You should contact your gastroenterologist or primary care physician today to schedule an urgent appointment for evaluation and possible esophageal dilation procedure. While waiting for medical care, modify your diet by eating soft, moist foods cut into small pieces, avoiding dry or hard foods, and drinking liquids with meals. For EOE management, your doctor may recommend an elimination diet (removing common triggers like dairy, wheat, eggs, soy, nuts, and seafood) or prescribe medications such as swallowed topical steroids (fluticasone 440-880 mcg twice daily or budesonide 1 mg twice daily) 1. Proton pump inhibitors like omeprazole (20-40 mg daily) may also help. EOE causes inflammation and narrowing of your esophagus, making swallowing difficult and potentially dangerous. Dilation can provide immediate relief by stretching the narrowed areas, while dietary modifications and medications address the underlying inflammation. Don't delay seeking care as worsening swallowing difficulties can lead to food impaction requiring emergency intervention. Some key points to consider:
- The AGA/JTF suggests endoscopic dilation over no dilation for adult patients with dysphagia from a stricture associated with EoE 1.
- Esophageal dilation does not address the esophageal inflammation associated with EoE, but it can provide symptom improvement in 87% of patients who undergo the procedure 1.
- The British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines recommend commencing treatment in patients with EoE with a single modality therapy of either diet or pharmacotherapy 1.
- Combination therapy of drugs and diet should be reserved for selected patients who fail monotherapy and have access to a multiprofessional team including a dietitian to follow them up and monitor response carefully 1.
From the Research
Symptoms and Diagnosis
- Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated esophageal disorder that can cause dysphagia, food impaction, and esophageal strictures 2, 3, 4.
- The initial presentation of EoE includes symptoms of esophageal dysfunction, such as solid-food dysphagia, vomiting, and feeding difficulties 2, 3, 4.
- Diagnosis requires compatible clinical symptoms and histologic evidence of eosinophil-predominant inflammation of the esophageal epithelium with more than 15 eosinophils per high-power field 2, 3, 4.
Treatment Options
- The mainstay of management for EoE includes the 3 D's: diet, drugs, and dilation 2.
- Dietary modifications, such as elimination diets, can be effective in managing EoE 2, 5, 3, 6, 4.
- Medications, including proton pump inhibitors, swallowed topical glucocorticoids, and dupilumab, can also be used to manage EoE 2, 5, 3, 6, 4.
- Esophageal dilation may be required to manage strictures and improve obstructive symptoms, such as dysphagia and food impaction 2, 5, 3, 6, 4.
Modified Diet
- Various elimination diets, including 1-food, 2-food, 4-food, and 6-food elimination diets, have been found to be effective in managing EoE 2.
- Dietary therapy with amino acid formula or empirical food elimination can also be used to manage EoE 3.