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. This recommendation is based on the most recent and highest quality study, which suggests that PPI therapy is effective in inducing histological and clinical remission in patients with EoE 1. The study found that treatment with omeprazole 20 mg twice daily for 8-12 weeks resulted in a significant reduction in esophageal eosinophilia and improvement in symptoms.
Key Points to Consider
- PPI therapy should be given for at least 8-12 weeks prior to assessment of histological response while on treatment 1
- Omeprazole is the only PPI that has been assessed for the treatment of EoE, and it is recommended to use a dose of 20 mg twice daily 1
- A meta-analysis found a non-significant trend towards increased efficacy for two times per day dosing compared with a one time per day dose 1
- A significant difference in clinicopathological response rates was reported in patients with EoE prescribed high-dose PPI, with response rates of 50.8% compared to 35.8% for standard or low-dose regimes 1
Additional Treatment Options
- Topical steroids, such as fluticasone or budesonide, may be prescribed if PPIs are ineffective 1
- Dietary therapy, including elimination diets or elemental diets, may also be effective in treating EoE 1
- Endoscopic dilation may be necessary to relieve dysphagia in patients with significant esophageal narrowing 1
Long-term Management
- Long-term maintenance therapy is often required as EoE is typically a chronic condition that can recur when treatment is discontinued 1
- A prospective study found that 70.1% of patients who responded to an initial 8-week course of PPI treatment exhibited long-term histological remission over 12 months 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.