From the Guidelines
The treatment for eosinophilic esophagitis (EoE) should start with proton pump inhibitors (PPIs), specifically omeprazole 20mg twice daily, for at least 8-12 weeks, as recommended by the British Society of Gastroenterology and the British Society of Paediatric Gastroenterology, Hepatology and Nutrition 1. This approach is based on the latest guidelines, which suggest that PPI therapy can be effective in managing EoE, despite not being licensed for this specific use. The recommended dose and duration of treatment are crucial in achieving the best possible outcomes.
Key Considerations
- The use of PPIs, such as omeprazole, has been shown to reduce inflammation and improve symptoms in patients with EoE 1.
- Topical steroids, including swallowed fluticasone or budesonide oral suspension, can be considered if PPIs are ineffective, as they have been found to be effective in reducing esophageal eosinophil counts 1.
- Dietary therapy, such as targeted elimination of specific food triggers or empiric elimination diets, can also be an effective approach in managing EoE 1.
- Endoscopic dilation may be necessary for patients with severe strictures causing dysphagia, and biologic therapies, such as dupilumab, are emerging options for refractory cases.
Treatment Approach
- First-line therapy: PPIs, such as omeprazole 20mg twice daily, for at least 8-12 weeks 1.
- Second-line therapy: Topical steroids, including swallowed fluticasone or budesonide oral suspension, if PPIs are ineffective 1.
- Dietary therapy: Targeted elimination of specific food triggers or empiric elimination diets, as an alternative or adjunct to medication 1.
- Endoscopic dilation and biologic therapies: Considered for patients with severe strictures or refractory cases, respectively.
From the Research
Treatment Options for Eosinophilia Esophagitis
- The primary treatment goals for eosinophilic esophagitis (EoE) are to improve clinical symptoms, resolve esophageal eosinophilia, and improve quality of life 2.
- Standard treatment modalities include dietary modifications, esophageal dilation, and pharmacologic therapy, such as corticosteroids, proton pump inhibitor medications, and biologics 2, 3, 4.
- Corticosteroids may lead to clinical symptom improvement, histological improvement, and endoscopic improvement, with a lower risk of withdrawals due to adverse events compared to placebo 2.
- Biologics, such as dupilumab, may result in little to no difference in clinical improvement, but may lead to histological improvement and endoscopic improvement 2, 5.
Pharmacologic Therapies
- Proton pump inhibitors (PPIs) are commonly used as a first-line treatment for EoE, with a histologic response rate of 41.7% compared to 13.3% for placebo 3.
- Topical corticosteroids, such as fluticasone and budesonide, are effective in inducing histologic remission in 64.9% of patients compared to 13.3% for placebo 3.
- Dupilumab is a biologic therapy that has shown efficacy in treating EoE, but is unlikely to replace PPIs or topical corticosteroids as first-line therapy except in specific circumstances 5.
Dietary Therapies
- Dietary modifications, such as elemental diet or empirical food elimination, may be effective in treating EoE, especially in pediatric patients 3, 4.
- Feeding therapy may be used adjunctively in children with food aversion or feeding dysfunction 4.