Eosinophilic esophagitis medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

The optimal treatment of eosinophilic esophagitis remains uncertain. The endpoints of therapy of eosinophilic esophagitis include improvements in clinical symptoms and esophageal eosinophilic inflammation. An eight-week course of therapy with topical corticosteroids (fluticasone or budesonide) may be used as the first-line pharmacologic therapy. Prednisone may be considered in patients unresponsive to initial steroids therapy. Patients without symptomatic and histologic improvement after topical steroids may benefit from a longer course of topical steroids, higher doses of topical steroids, systemic steroids, elimination diet, or esophageal dilation. Evaluation by an allergist for coexisting atopic disorders and food and environmental allergens is advisable. Allergen elimination usually leads to improvement in dysphagia and reduction of eosinophil infiltration. Graduated dilation of esophageal stricture should be performed with caution to minimize the risk of iatrogenic perforation.

References

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