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 medical therapy of the EoE is as follows:[1][2][3][4][3][5][6][7]
- The optimal treatment of eosinophilic esophagitis remains uncertain.
Steroid Therapy
- 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.
Dietary Modification
- The dietary strategies are as follows:
- Elemental diet- highly effective in both adults and chlidren, but it is limited by patient tolerability.
- Empiric six-food elimination diet (SFED)- six most common foods that trigger EoE are as follows: soy, fish, cow milk,nuts, eggs, wheat.
- Limited diet driven by allergy testing and patient history- The allergy testing directed diet approach, although effective in the pediadric 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 remedying their sickness by means of getting rid of a nutritional trigger greater 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 intermittent use of quick courses of topical steroids.
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.
- ↑ 3.0 3.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.