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 prior to assessment of histological response while on treatment. 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 also notes that a dose of omeprazole 20 mg twice daily is likely to reflect current widespread clinical practice, and that treatment duration of 8-12 weeks is associated with a higher response rate.

Some key points to consider when initiating PPI therapy for EoE include:

• The use of omeprazole 20 mg twice daily, as this dose has been shown to be effective in inducing remission 1
• Treatment duration of at least 8-12 weeks, as this has been associated with a higher response rate 1
• The importance of regular follow-up with repeat endoscopy to assess treatment response, typically after 8-12 weeks of therapy
• The need to clearly explain the indication for PPI therapy to patients and their general practitioners, as PPI therapy is not licensed for use in EoE, but has been shown to be effective in certain situations 1

It's also worth noting that while PPI therapy is the recommended initial treatment, other options such as topical steroids or dietary modifications may be considered if PPIs are ineffective or not tolerated. However, the current evidence suggests that PPI therapy is a effective and widely practiced treatment for EoE, and should be considered as the first-line 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.

Additional Considerations

• Esophageal dilation may be necessary for patients with symptomatic esophageal narrowing 4.
• New formulations of topical corticosteroids and investigational therapies targeting specific molecular pathways are being developed and may offer additional treatment options in the future 3.