Eosinophilic esophagitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*The medical therapy of the EoE is as follows:<ref>{{Cite journal| doi = 10.1038/ajg.2013.71| issn = 1572-0241| volume = 108| issue = 5| pages = 679–692; quiz 693| last1 = Dellon| first1 = Evan S.| last2 = Gonsalves| first2 = Nirmala| last3 = Hirano| first3 = Ikuo| last4 = Furuta| first4 = Glenn T.| last5 = Liacouras| first5 = Chris A.| last6 = Katzka| first6 = David A.| last7 = American College of Gastroenterology| title = ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)| journal = The American Journal of Gastroenterology| date = 2013-05| pmid = 23567357}}</ref> | *The medical therapy of the EoE is as follows:<ref>{{Cite journal| doi = 10.1038/ajg.2013.71| issn = 1572-0241| volume = 108| issue = 5| pages = 679–692; quiz 693| last1 = Dellon| first1 = Evan S.| last2 = Gonsalves| first2 = Nirmala| last3 = Hirano| first3 = Ikuo| last4 = Furuta| first4 = Glenn T.| last5 = Liacouras| first5 = Chris A.| last6 = Katzka| first6 = David A.| last7 = American College of Gastroenterology| title = ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)| journal = The American Journal of Gastroenterology| date = 2013-05| pmid = 23567357}}</ref><ref name="pmid4946566">{{cite journal |vauthors=de Vernejoul P, Mestan J, Delaloye B |title=The application of radiocardiography in measuring pulmonary pressures and resistances |journal=Helv Med Acta |volume=36 |issue=1 |pages=67–78 |year=1971 |pmid=4946566 |doi= |url=}}</ref> | ||
*The optimal treatment of [[eosinophilic esophagitis]] remains uncertain. | *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|'''budesonide''']] | *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|'''budesonide''']] | ||
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**Dietary elimination | **Dietary elimination | ||
**Endoscopic dilation | **Endoscopic dilation | ||
*Oropharyngeal and esophageal candidiasis have been reported in patients treated with oral fluticasone, | |||
*Evaluation by an allergist for coexisting [[atopy|atopic disorders]] and food and environmental [[allergens]] is advisable. | *Evaluation by an allergist for coexisting [[atopy|atopic disorders]] and food and environmental [[allergens]] is advisable. | ||
*[[Allergen]] elimination usually leads to improvement in [[dysphagia]] and reduction of [[eosinophil]] infiltration. | *[[Allergen]] elimination usually leads to improvement in [[dysphagia]] and reduction of [[eosinophil]] infiltration. | ||
Revision as of 20:12, 11 December 2017
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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 medical therapy of the EoE is as follows:[1][2]
- 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
- Children
- 88–440 mcg/day fluticasone
- 1 mg/day budesonide
- Adults
- 880–1760 mcg/day fluticasone
- 2 mg/day budesonide may be used as the first-line pharmacologic therapy.
- Patients without symptomatic and histologic improvement after topical steroids
- Long course or higher doses of topical steroids
- Systemic steroids with prednisone
- Dietary elimination
- Endoscopic dilation
- Oropharyngeal and esophageal candidiasis have been reported in patients treated with oral fluticasone,
- 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
- ↑ 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) - ↑ 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.