Pharmacologic Management of Eosinophilic Esophagitis

Medications, including PPIs, STSs, and dupilumab, are highly effective therapies for the treatment of EoE. Choice of therapy is dependent on shared decision -making, and factors such as ease of use, safety, cost, and efficacy all should be discussed with patients and/or families prior to embarking on therapy. Response to PPI is no longer required to diagnose EoE. However, given the safety profile and ease of use, PPIs are the most common medication utilized early in the disease course. For those who do not respond to PPIs, topical corticosteroids are an excellent alternative and can be effective for both short-term and long-term use. Neither class of medication is disease modifying, and both require consistent dosing to be effective. P -CABs are a novel class of medication that could serve as an alternative to PPIs in the future, although more work is needed to understand their efficacy in EoE. Biologics provide a more targeted mechanism of action with similar efficacy for dupilumab as for topical corticosteroids. While early trials of biologics were disappointing, recent investigation has seen more success including the first FDA -approved medication for EoE. Dupilumab is not likely to replace PPIs or topical corticosteroids as first -line therapy except in highly specific circumstances, such as in patients with multiple atopic conditions. Identification of novel biologic pathways and the development of small molecules may lead to a wider diversity of treatment options in the future.