From the Research
The initial approach to managing esophageal thickening should involve a combination of diagnostic evaluation and empiric treatment with a proton pump inhibitor (PPI), such as omeprazole 20-40mg twice daily, for 8-12 weeks, as evidenced by the most recent study 1. This approach is based on the understanding that gastroesophageal reflux disease (GERD) is a common cause of esophageal thickening. Simultaneously, an upper endoscopy with biopsies should be performed to rule out malignancy and identify specific conditions like eosinophilic esophagitis or infectious causes, as recommended by recent guidelines 2. Key considerations in the management of esophageal thickening include:
- Diagnostic evaluation to identify underlying causes
- Empiric treatment with PPIs, with twice-daily dosing showing higher remission rates 1
- Lifestyle modifications, including elevation of the head of the bed, avoiding meals within 3 hours of bedtime, weight loss if overweight, and avoiding trigger foods
- Additional testing, such as esophageal manometry and 24-hour pH monitoring, if symptoms persist despite PPI therapy, to evaluate for motility disorders or refractory GERD, as suggested by recent studies 3, 4. The most recent and highest quality study 2 supports the use of PPIs as a first-line treatment for esophageal thickening, with the goal of reducing symptoms and preventing complications. By prioritizing the most recent and highest quality evidence, we can ensure that patients receive the most effective and up-to-date treatment for esophageal thickening, ultimately improving morbidity, mortality, and quality of life outcomes.