What is the initial treatment for Eosinophilic Esophagitis (EoE)?

From the Guidelines

The initial treatment for Eosinophilic Esophagitis (EoE) should be proton pump inhibitor (PPI) therapy, specifically omeprazole 20 mg twice daily, for at least 8-12 weeks, as it has been shown to be effective in inducing histological and clinical remission in patients with EoE. This recommendation is based on the most recent and highest quality study, which reported a significant difference in clinicopathological response rates in patients with EoE prescribed high-dose PPI, with a response rate of 50.8% compared to 35.8% in those given standard or low-dose regimes 1.

Key Considerations

• PPI therapy should be given for at least 8-12 weeks prior to assessment of histological response while on treatment, as treatment duration of 8-10 weeks conferred a response rate of 50.4%, and longer treatment duration (>10-12 weeks) was associated with a greater rate of response (65.2%) 1.
• The use of PPI therapy in EoE is not licensed, but its use in certain situations has been shown to be effective, and it is essential to inform patients and their general practitioners of the reasons for the prescription of PPI, which is for the management of EoE, rather than as a GORD treatment 1.
• A systematic review and meta-analysis of 33 studies reported partial clinical and histological response rates of 60.8% and 50.5%, respectively, with PPI treatment, and a more recent systematic review and meta-analysis of 11 trials ranked PPI treatment as more effective than placebo, systemic steroid and biological treatment (anti-interleukin-5 antibody) but less effective than topical budesonide preparations 1.

Treatment Approach

• The goal of therapy is to reduce esophageal inflammation, alleviate symptoms, and prevent complications like strictures and food impactions.
• Treatment success is monitored through symptom improvement and follow-up endoscopy with biopsies to assess eosinophil counts.
• If PPIs are ineffective, topical corticosteroids like fluticasone or budesonide oral suspension may be recommended for 8-12 weeks, and dietary therapy, including elimination diets, may also be considered.

From the Research

Initial Treatment for Eosinophilic Esophagitis (EoE)

The initial treatment for Eosinophilic Esophagitis (EoE) typically involves a combination of medical and dietary approaches.

• The main treatment options include:
  • Swallowed topical corticosteroids (STCs) 2
  • Proton-pump inhibitors (PPIs) 2, 3, 4, 5, 6
  • Dietary intervention, such as empirical elimination diets or elemental diets 2, 3, 4, 5, 6
• These treatments aim to reduce inflammation, prevent fibrosis, and relieve symptoms such as dysphagia and food impaction.
• The choice of initial treatment may depend on various factors, including the patient's age, symptoms, and preferences, as well as the presence of any underlying conditions or allergies.

Treatment Options

• Proton-pump inhibitors (PPIs) are often used as a first-line treatment for EoE, as they are effective in reducing inflammation and symptoms in many patients 3, 4, 5, 6.
• Swallowed topical corticosteroids (STCs) are also commonly used to treat EoE, particularly in patients who do not respond to PPIs or have more severe symptoms 2, 4, 5.
• Dietary interventions, such as empirical elimination diets or elemental diets, may be recommended for patients who do not respond to medical treatment or have specific food triggers 2, 3, 4, 5, 6.
• Endoscopic dilation may be necessary for patients with severe esophageal narrowing or strictures 2, 3, 4, 5, 6.