From the Guidelines
I strongly recommend renewing the patient's Omeprazole prescription and proceeding with the GI consult for EGD with dilation to address the esophageal stenosis caused by eosinophilic esophagitis (EOE), as suggested by the AGA/JTF guidelines 1. The patient should be prescribed a mechanically soft (MC) diet to help manage dysphagia symptoms. For the Omeprazole renewal, a typical dose would be 20-40mg once daily, taken 30 minutes before breakfast.
Key Considerations
- The GI consultation is appropriate given the progressive dysphagia over two weeks, which suggests worsening stenosis requiring endoscopic evaluation and possible dilation, as recommended by the AGA/JTF guidelines 1.
- While awaiting the procedure, the mechanically soft diet will help reduce the risk of food impaction by avoiding foods that are difficult to chew or swallow.
- Omeprazole, a proton pump inhibitor, helps manage EOE by reducing acid production and potentially decreasing eosinophilic inflammation in the esophagus, as suggested by the AGA/JTF guidelines 1.
Patient Advice
- The patient should be advised to thoroughly chew food, eat slowly, and stay upright for 30 minutes after meals to minimize swallowing difficulties.
- Follow-up should be scheduled after the EGD to assess treatment response and adjust management as needed.
Treatment Rationale
- The use of topical glucocorticosteroids is recommended by the AGA/JTF guidelines 1 for patients with EoE, but in this case, the patient is already on Omeprazole, which can help manage EOE symptoms.
- The AGA/JTF guidelines 1 also suggest using an elemental diet or an empiric 6-food elimination diet, but these options may not be necessary for this patient at this time, given the planned GI consult and EGD with dilation.
From the FDA Drug Label
2.1 Recommended Adult Dosage Regimen by Indication Table 1: Recommended Dosage Regimen of Omeprazole in Adults by Indication Indication Dosage of Omeprazole Treatment of Active Duodenal Ulcer 20 mg once daily 4 weeks ... Treatment of EE due to Acid-Mediated GERD 20 mg once daily 4 to 8 weeks Maintenance of Healing of EE due to Acid-Mediated GERD 20 mg once daily
The patient has esophageal stenosis from EOE, and the dosage for Treatment of EE due to Acid-Mediated GERD is 20 mg once daily for 4 to 8 weeks. For Maintenance of Healing of EE due to Acid-Mediated GERD, the dosage is 20 mg once daily. Since the patient is requesting a renewal of omeprazole, the dosage for maintenance of healing can be considered, which is 20 mg once daily 2.
From the Research
Patient Presentation and Diagnosis
- The patient is a 45-year-old male presenting with trouble swallowing, which started two weeks ago and has been increasing.
- The patient's symptoms are consistent with esophageal stenosis from Eosinophilic Esophagitis (EoE), a chronic and progressive immune-mediated esophageal disorder 3.
- EoE is characterized by symptoms of esophageal dysfunction, including solid-food dysphagia, and is often associated with other atopic conditions such as allergic rhinitis, bronchial asthma, and eczema 3.
Treatment Options
- The mainstay of management for EoE includes the 3 D's: diet, drugs, and dilation 3, 4.
- Dietary modifications, such as elimination diets, can be effective in managing EoE symptoms 3, 5.
- Medications, including proton pump inhibitors (e.g., Omeprazole) and topical glucocorticoids, can help alleviate symptoms and reduce inflammation 3, 5.
- Esophageal dilation is reserved for patients with esophageal strictures or narrow caliber esophagus who have persistent dysphagia or food impaction despite anti-inflammatory treatment 6, 5.
Request for Omeprazole Renewal
- The patient's request for Omeprazole renewal is consistent with the recommended treatment for EoE, as proton pump inhibitors can help reduce symptoms and inflammation 3, 5.
- However, it is essential to monitor the patient's response to treatment and adjust the therapy as needed to prevent long-term complications such as esophageal fibrosis and stricture formation 3, 7.