Eosinophilic esophagitis medical therapy

Jump to navigation Jump to search

Eosinophilic Esophagitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Eosinophilic Esophagitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

X Ray

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Future or Investigational Therapies

Case Studies

Case #1

Eosinophilic esophagitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Eosinophilic esophagitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Eosinophilic esophagitis medical therapy

CDC on Eosinophilic esophagitis medical therapy

Eosinophilic esophagitis medical therapy in the news

Blogs on Eosinophilic esophagitis medical therapy

Directions to Hospitals Treating Eosinophilic esophagitis

Risk calculators and risk factors for Eosinophilic esophagitis medical therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Ajay Gade MD[2]];Rithish Nimmagadda,MBBS.[3]

Overview

The optimal treatment of eosinophilic esophagitis remains uncertain. An eight-week course of therapy with topical corticosteroids (fluticasone or budesonide) may be used as the first-line pharmacologic therapy. Allergen elimination usually leads to improvement in dysphagia and reduction of eosinophil infiltration. Esophageal dilation of is generally reserved for refractory cases with esophageal stricture.

Medical Therapy

Steroid Therapy

Monoclonal Antibody Therapy

  • Dupilumab blocks IL-4 and IL-13 cytokine signaling, which is critical for T helper type 2 (Th2) cell-mediated inflammation production and related to several inflammatory illnesses (ie, asthma, atopic dermatitis). Dupilumab is used to treat eosinophilic esophagitis in adults and pediatric patients one year of age and up. It is injected subcutaneously, and the dosage is determined by weight.
  • Patients weighing 40 kg or more should take 300 mg once a week
  • patients weighing 30 to <40 kg should take 300 mg once every other week
  • patients weighing 15 to <30 kg should take 200 mg once every other week

Dietary Modification

  • The dietary strategies are as follows:
  • Elemental diet- highly effective in both adults and children, but it is limited by patient tolerability.
  • Empiric six-food elimination diet (SFED)- the most common foods that trigger EoE are: soy, fish, cow milk, nuts, eggs, wheat.
  • Limited diet driven by allergy testing and patient history- The allergy testing directs diet approach, although effective in the pediatric group has only moderate success in adults.
  • The goal of dietary therapy is identification and removal of food antigens and consequently remove the sensitization.
  • Diet therapy gives patients an alternative to control their disease, many patients find the idea of managing their sickness by means of removing the nutritional trigger more appealing than taking a drug to counteract the downstream inflammatory response.
  • It is far vital to emphasize that the stern dietary elimination of multiple foods is only for a limited time but the long-term goal is the identify and remove the triggering dietary elements.
  • Prolonged deviation from the elimination diet can be managed via the intermittent use of quick courses of topical steroids.

Esophageal Dilation

References

  1. Dellon, Evan S.; Gonsalves, Nirmala; Hirano, Ikuo; Furuta, Glenn T.; Liacouras, Chris A.; Katzka, David A.; American College of Gastroenterology (2013-05). "ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)". The American Journal of Gastroenterology. 108 (5): 679–692, quiz 693. doi:10.1038/ajg.2013.71. ISSN 1572-0241. PMID 23567357. Check date values in: |date= (help)
  2. de Vernejoul P, Mestan J, Delaloye B (1971). "The application of radiocardiography in measuring pulmonary pressures and resistances". Helv Med Acta. 36 (1): 67–78. PMID 4946566.
  3. Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE (2005). "Eosinophilic esophagitis: a 10-year experience in 381 children". Clin. Gastroenterol. Hepatol. 3 (12): 1198–206. PMID 16361045.
  4. Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR (2006). "Eosinophilic esophagitis in adults--no clinical relevance of wheat and rye sensitizations". Allergy. 61 (12): 1480–3. doi:10.1111/j.1398-9995.2006.01224.x. PMID 17073881.
  5. Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA (2003). "Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents". Am. J. Gastroenterol. 98 (4): 777–82. doi:10.1111/j.1572-0241.2003.07390.x. PMID 12738455.
  6. Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, Melin-Aldana H, Li BU (2006). "Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis". Clin. Gastroenterol. Hepatol. 4 (9): 1097–102. doi:10.1016/j.cgh.2006.05.026. PMID 16860614.
  7. Lucendo AJ, Arias Á, González-Cervera J, Yagüe-Compadre JL, Guagnozzi D, Angueira T, Jiménez-Contreras S, González-Castillo S, Rodríguez-Domíngez B, De Rezende LC, Tenias JM (2013). "Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease". J. Allergy Clin. Immunol. 131 (3): 797–804. doi:10.1016/j.jaci.2012.12.664. PMID 23375693.
  8. Morrey BF, Tanaka S, An KN (1991). "Valgus stability of the elbow. A definition of primary and secondary constraints". Clin. Orthop. Relat. Res. (265): 187–95. PMID 2009657.
  9. Parkhouse RM, Guarnotta G (1978). "Rapid binding test for detection of alloantibodies to lymphocyte surface antigens". Curr. Top. Microbiol. Immunol. 81: 142. PMID 357091.
  10. Ukleja A, Shiroky J, Agarwal A, Allende D (2014). "Esophageal dilations in eosinophilic esophagitis: a single center experience". World J. Gastroenterol. 20 (28): 9549–55. doi:10.3748/wjg.v20.i28.9549. PMC 4110588. PMID 25071351.
  11. Richter JE (2015). "Esophageal dilation in eosinophilic esophagitis". Best Pract Res Clin Gastroenterol. 29 (5): 815–828. doi:10.1016/j.bpg.2015.06.015. PMID 26552780.
  12. Schoepfer A (2014). "Treatment of eosinophilic esophagitis by dilation". Dig Dis. 32 (1–2): 130–3. doi:10.1159/000357091. PMID 24603396.
  13. Hirano I. "Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis year=2019". doi:10.1053/j.gastro.2019.09.042. Check |doi= value (help). PMID 31593702.

Template:Gastroenterology