From the Guidelines
Endoscopic dilatation is a highly effective procedure for managing pain in patients with eosinophilic esophagitis, particularly those with fibrostenotic disease, as it improves symptoms and is safe to perform 1.
Key Points to Consider
- The procedure is recommended for patients with strictures and symptoms despite effective anti-inflammatory therapy, such as topical steroids 1.
- Endoscopic dilatation can be performed using either balloon or bougie dilators, with no differences in outcome between the two methods 1.
- The risks of perforation during endoscopy or dilatation of EoE strictures are low, at 0.38%, and are comparable to those seen in other benign conditions of the oesophagus 1.
- Patients should be warned about the potential for pain during and after the procedure, as well as the risk of deep mucosal tears, which are fairly common (9%) 1.
Important Considerations for Patient Care
- Dietary management and medication therapy, such as proton pump inhibitors and topical corticosteroids, should be optimized before considering endoscopic dilatation 1.
- Patients should be educated on how to minimize pain, including eating slowly, chewing thoroughly, and staying upright for 2-3 hours after meals.
- The decision to perform endoscopic dilatation should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and response to other treatments 1.
From the Research
Pain Management in Eosinophilic Esophagitis
To manage pain in eosinophilic esophagitis, several procedures can be considered:
- Swallowed topical corticosteroids (STCs) such as fluticasone and budesonide, which have been shown to be effective in reducing inflammation and improving symptoms 2, 3, 4, 5
- Proton-pump inhibitors (PPIs), which can help reduce acid production and alleviate symptoms 2, 6
- Dietary therapy, including elemental diets or empirical food elimination, which can help identify and avoid trigger foods 2, 6
- Endoscopic dilation, which can help relieve narrowing of the esophagus and improve swallowing 2, 6
Procedures for Symptom Relief
The following procedures can help relieve symptoms of eosinophilic esophagitis:
- Endoscopy with biopsy to assess the extent of inflammation and monitor response to treatment 6, 5
- Esophageal dilation to relieve narrowing and improve swallowing 2, 6
- Topical corticosteroid therapy, which can be administered in various formulations, including swallowed nasal drop suspensions and oral viscous solutions 4
Effective Treatment Options
Studies have shown that the following treatment options can be effective in managing eosinophilic esophagitis:
- Budesonide orodispersible tablets, which have been shown to be highly effective in achieving clinico-histological remission 4
- Higher doses of topical corticosteroids, which can improve treatment outcomes 4
- Combination therapy, including PPIs and topical corticosteroids, which can be considered for patients with severe symptoms or inadequate response to single therapy 2, 6