Treatment of eosinophilic esophagitis

Introduction: Eosinophilic esophagitis (EoE) has been increasingly reported throughout the world with a 1/2000 in the USA. The symptoms of EoE are similar to gastroesophageal reflux disease (GERD) and include vomiting, pain, regurgitation and dysphagia. EoE is characterized by an eosinophils in the esophagus (> 15 eosinophils per high-power field) without infiltration in other parts of the gastrointestinal tract. Patients with EoE often have a history of atopy, such as elevated serum IgE, allergic diseases (including asthma, atopic dermatitis or allergic rhinitis), and sensitization to foods and aeroallergens. Most studies have demonstrated that food allergies play a key role as the major antigen trigger in patients. The treatment options vary along two main pathways: treating the underlying inflammation with offlabel use of topical steroids or eliminating the food allergens. Food allergens can be identified by either allergy testing or using an empiric elimination diet of the most common allergens. Both diet methods are equally effective with 50 - 70% success rate. The ideal treatment option depends on the family and patient preference toward medications versus diet therapy and weighing the quality of life. Areas covered: This review covers the diagnosis of EoE, and medical and dietary therapy of EoE. Expert opinion: There are two main methods for treating EoE: off-label use of topical steroids and dietary therapy. They are equally efficacious and the choice depends on family desires of treating the symptoms versus treating the cause of the disease and weighing various quality of life measures.