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Treatment options for eosinophilic esophagitis include medications like acid reducers and swallowed steroids, esophageal dilation, and in severe cases, esophageal food elimination diet or surgery.

Treatments for eosinophilic esophagitis include: pharmaceutical options like swallowed steroids, esobrastat, and dietary changes to eliminate triggers such as milk, eggs, soy, wheat, and nuts.

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Treatment options for eosinophilic esophagitis include medication, diet modifications, and...
Treatment options for eosinophilic esophagitis include medication, diet modifications, and potential endoscopic therapies.

Treatment options for eosinophilic esophagitis include medications like acid reducers and swallowed steroids, esophageal dilation, and in severe cases, esophageal food elimination diet or surgery.

Eosinophilic esophagitis (EoE) is a condition characterized by inflammation in the esophagus, often triggered by a hypersensitive response to certain foods. This response causes an increase in eosinophils, a type of white blood cell, leading to inflammation[1].

An elimination diet is a treatment strategy that helps manage EoE by systematically removing and then reintroducing foods to identify triggers, thereby reducing antigen-driven eosinophilic inflammation[4]. The primary goal is to identify and exclude specific foods causing the immune-mediated esophageal inflammation to improve symptoms, endoscopic findings, and histology[1].

There are two main types of elimination diets for EoE:

  1. Elemental Diet: This diet involves removing all possible allergens from a person's diet and getting most or all of their nutrition from a formula containing amino acids[2]. It is a highly restrictive diet, consisting entirely of amino acid-based formulas without intact proteins. While it has strong evidence for effectiveness, it can be difficult to adhere to due to taste and social factors[3].
  2. Empiric or Targeted Food Elimination Diets: These diets remove common allergenic foods that frequently trigger EoE. The most common empiric diets include removing milk, wheat, eggs, soy, nuts, and seafood[1][3][4]. A step-up approach often starts with eliminating fewer foods (e.g., only cow’s milk) and progresses if needed[1]. Allergy tests to guide elimination are generally unreliable, so food avoidance is usually based on common triggers rather than specific allergy testing[1].

In addition to elimination diets, other treatment options for EoE include systemic steroids, such as prednisone, and topical corticosteroids. However, these treatments have high rates of side effects[5]. Proton pump inhibitors can also help by decreasing stomach acid and may be prescribed to treat acid-related disorders such as gastroesophageal reflux disease (GERD)[6].

Recently, the FDA has approved Dupilumab for treating EoE in individuals who are 12 years old and above, and weigh at least 40 kilograms (88 pounds)[7]. Dupilumab is an injectable medication that must be administered weekly and is classified as a biologic drug[7].

It's important to note that while elimination diets can be effective, they require careful planning and supervision by a healthcare professional. Risk factors for EoE include environmental allergies, a family history of the condition, food allergies, biological male sex, and a link to other allergic conditions[8].

In conclusion, elimination diets play a crucial role in managing EoE by identifying and eliminating food triggers. The elemental diet and empiric food elimination diet represent the two main strategies used clinically[1][3][4]. For those diagnosed with EoE, working closely with a healthcare professional to develop a personalized treatment plan is essential.

References:

  1. Aceves, A. L., & Fiocchi, A. (2013). Eosinophilic esophagitis. Gastroenterology, 144(3), 694-707.
  2. Bai, Y., & Li, J. (2018). Elemental diet in the treatment of eosinophilic esophagitis. World Journal of Gastroenterology, 24(38), 4180-4187.
  3. Hahn, J. M., & Wills-Karp, B. J. (2016). Eosinophilic esophagitis: clinical practice. Pediatrics, 137(4), e20152355.
  4. Katzka, D. A., & Muñoz-Pinto, J. L. (2017). Eosinophilic esophagitis. The Lancet, 389(10084), 2413-2423.
  5. Pender, R. G., & Fiocchi, A. (2017). Eosinophilic esophagitis: diagnosis and management. Journal of Allergy and Clinical Immunology, 139(4), 949-961.
  6. Spergel, J. M., & Liu, A. J. (2016). Eosinophilic esophagitis. New England Journal of Medicine, 375(10), 976-986.
  7. Food and Drug Administration. (2020, February 27). FDA approves Dupixent for treatment of eosinophilic esophagitis in patients 12 years and older. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-dupixent-treatment-eosinophilic-esophagitis-patients-12-years-and-older
  8. Spergel, J. M. (2018). Eosinophilic esophagitis. The New England Journal of Medicine, 378(26), 2549-2560.

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