From the Guidelines
The treatment for Eosinophilic Esophagitis (EoE) should start with proton pump inhibitors (PPIs) such as omeprazole 20mg twice daily for at least 8-12 weeks. This recommendation is based on the most recent and highest quality study available, which suggests that PPI therapy can be effective in managing EoE, although the evidence is graded as low 1. The use of PPIs is recommended due to their potential anti-inflammatory effects and ability to reduce acid production in the esophagus.
Key Considerations
- The dose of omeprazole recommended is 20mg twice daily, as specified in the guidelines 1.
- Treatment duration should be at least 8-12 weeks before assessing the histological response while on treatment 1.
- If PPIs are ineffective, other treatment options such as topical corticosteroids may be considered, including swallowed fluticasone or budesonide oral suspension 1.
- Dietary therapy is another cornerstone of treatment, which may include empiric elimination diets or targeted elimination of specific food triggers, although the evidence for these approaches is variable 1.
Additional Treatment Options
- Topical corticosteroids, such as swallowed fluticasone (440-880mcg twice daily) or budesonide oral suspension (1mg twice daily for adults, 0.5mg twice daily for children), can reduce esophageal inflammation by suppressing eosinophil activity 1.
- Dietary modifications, including empiric elimination diets that remove common allergens like dairy, wheat, eggs, soy, nuts, and seafood, may also be effective in managing EoE symptoms 1.
- For patients with severe strictures causing dysphagia, endoscopic dilation may be necessary to expand the narrowed esophagus 1.
Monitoring and Long-term Management
- Treatment success is monitored through symptom improvement and follow-up endoscopy with biopsies to confirm reduction in eosinophil counts 1.
- Long-term management is typically required as EoE is a chronic condition, with medication doses often adjusted to the minimum effective level for maintenance therapy 1.
From the Research
Treatment Options for Eosinophilic Esophagitis (EoE)
- The treatment for EoE includes elimination diets, high-dose proton pump inhibitors (PPI), and topical corticosteroids such as budesonide 2, 3, 4.
- A study found that 23% of patients with EoE responded to PPI therapy, while 69% of patients chose the elimination diet with PPI, resulting in complete remission in 52% of patients 2.
- Topical budesonide has been shown to be effective in treating EoE, with response rates up to 85% 3, 4.
- A randomized controlled trial found that aerosolized swallowed fluticasone and esomeprazole had similar histological responses for esophageal eosinophilia, but esomeprazole was superior in terms of clinical response, particularly in patients with established GERD 5.
- Oral viscous budesonide has been found to be effective in children with EoE, with 86.7% of patients responding to treatment 6.
Medication Options
- Proton pump inhibitors (PPI) such as esomeprazole 2, 5
- Topical corticosteroids such as budesonide 2, 3, 4, 6 and fluticasone 5
- Orodispersible budesonide tablets 3
- Oral viscous budesonide (OVB) 6