gastrointestinal disorders
Eosinophilic Esophagitis
Treatment of Eosinophilic Esophagitis
Proton pump inhibitors Topical corticosteroids Elimination diet Sometimes esophageal dilation In adults, first-line medical therapy is a proton pump inhibitor (PPI). In children, PPIs are typically used if dietary changes are ineffective. PPIs are thought to work via the eotaxin-3 pathway. If PPI therapy fails, topical corticosteroids are often given to treat eosinophilic esophagitis. Patients may use a multi-dose inhaler offluticasone(880 mcg twice a day); they puff the drug into their mouth without inhaling and then swallow it. Alternatively,budesonide1 to 2 mg oral viscus slurry can be taken 30 minutes after breakfast and 30 minutes after dinner.Budesonidecan also be mixed with a thickener (most often a sugar substitute) into a slurry and swallowed.Fluticasoneorbudesonideis given for at least 8 weeks to determine efficacy. If the patient achieves remission with either of these therapies, they are often continued indefinitely. Maintenance doses of these drugs are not well established. Recent studies show that monoclonal antibodies against interleukin-13 (IL-13) and IL-5 may be beneficial; further studies are ongoing. The six-food elimination diet is the most often recommended diet for eosinophilic esophagitis. This diet eliminates the foods most likely to causes IgE-mediated food reactions (milk, egg, soy, wheat, peanuts/tree nuts, fish/shellfish). It has been shown to be superior to an elimination diet that is based on skin and blood testing. Other variations of this elimination diet include the 2-4-6 step-up diet as well as partial elimination diets (eg, two foods, four foods). Studies show the elemental diet is successful in both adults and children but is often not practical in adults. Patients who have significant strictures may need careful esophageal dilation using a balloon or bougie; multiple, careful, progressive dilations are done to help prevent esophageal perforation. Injection and infusion therapies that target the eosinophil pathway in the body are being studied for eosinophilic esophagitis. 