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 recommended by the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition joint consensus guidelines 1.
Key Considerations
- PPI therapy has been shown to be effective in inducing histological and clinical remission in patients with EoE, with a strong level of recommendation and 100% level of agreement 1.
- The use of omeprazole 20 mg twice daily is recommended, with a clear explanation of its indication in correspondence with the primary care team 1.
- Treatment success is evaluated through symptom improvement and follow-up endoscopy with biopsies to confirm reduction in eosinophil count.
Alternative Approaches
- Topical steroids, such as fluticasone or budesonide, may be considered if PPI therapy is ineffective.
- Dietary modifications, including targeted elimination of specific food triggers or an empiric six-food elimination diet, may also be effective in managing EoE.
Important Notes
- PPI therapy is not licensed for use in EoE, but its use in certain situations has been shown to be effective, and patients and their general practitioners should be made aware of the reasons for its prescription 1.
- Long-term data on relapse rates on PPI are lacking, and further studies are needed to determine the optimal duration of treatment 1.
From the Research
Initial Treatment for Eosinophilic Esophagitis (EoE)
The initial treatment for Eosinophilic Esophagitis (EoE) typically involves a combination of medical therapies and dietary changes.
- The first line of treatment often includes proton pump inhibitors (PPIs) and/or topical corticosteroids, such as fluticasone and budesonide 2, 3, 4.
- Elimination diets, where common food triggers are removed, may also be recommended as an initial treatment approach 2, 4.
- Topical corticosteroids, such as swallowed fluticasone propionate, have been shown to be effective in inducing histologic remission in EoE patients 5, 6.
Treatment Outcomes
- Studies have demonstrated that PPI therapy can lead to histologic response in approximately 41.7% of patients, while topical corticosteroid treatment can achieve histologic remission in around 64.9% of patients 4.
- The effectiveness of these treatments can vary depending on individual patient factors, such as the presence of allergies or the severity of symptoms 5.
- Regular follow-up and monitoring are essential to assess treatment response and make adjustments as needed 2, 3.