Management of Eosinophilic Esophagitis: Dietary and Nondietary Approaches

Abstract

Eosinophilic esophagitis (EoE) is an allergen‐driven chronic inflammatory condition, characterized by symptoms related to esophageal dysfunction and confirmed histologically by esophageal mucosal eosinophilia. Since its first description in the 1990s, the incidence and prevalence of EoE have been on the rise. It is known to affect all ages of various ethnic backgrounds and both sexes; however, it is most seen in White males. Children with EoE often present with abdominal pain, nausea, vomiting, and failure to thrive, whereas adults with EoE typically present with dysphagia and food impaction. Diagnosis of EoE requires histologic confirmation of elevated esophageal eosinophils in a symptomatic patient, and only after secondary causes have been excluded. Because EoE is a chronic and progressively fibrostenotic disease, treatment goals include resolution of symptoms, induction and maintenance of disease remission, and prevention and possibly reversal of fibrostenotic complications, while minimizing treatment‐related adverse effects and improving quality of life. Treatment strategies include the “3 D's”—drugs, diet, and dilation. Standard drug therapies include proton‐pump inhibitors and topical corticosteroids. Dietary therapies include elemental diet, allergy testing–directed elimination diet, and empiric elimination diets. Endoscopic esophageal dilation for EoE strictures can alleviate esophageal symptoms but has no effect on mucosal inflammation. Recent progress in EoE research has made possible evidence‐based clinical guidelines. Ongoing pharmacologic trials show promise for novel biologic agents in the treatment of refractory EoE.

Analysis of the clinical and therapeutic management of patients with eosinophilic esophagitis at the Virgen Del Rocio Hospital

“…Solo 11 de nuestros pacientes realizaron dieta de eliminación empírica de alimentos. Este tipo de dieta está considerada de elección en los pacientes con EoE por su tasa de respuesta histológica que en estudios previos es del 68% 12 . En nuestra serie también observamos una tendencia a una mejor respuesta a las dietas de eliminación frente a las guiadas por pricktest, aunque las diferencias entre los dos abordajes dietéticos no fueron estadísticamente significativas.…”

Novel corticosteroid formulations in the treatment of eosinophilic esophagitis: what is the evidence?

“…Multiple guidelines are available to offer exhaustive and evidence-based treatment recommendations. We propose a treatment algorithm based on these guidelines, systematic reviews and expert consensus (figure 2) (1, 4,36,68,[83][84][85][86][87][88].…”

Recent Trends in the Management of Eosinophilic Esophagitis: A Systematic Review

“…Author's own creation EGD = Esophagogastroduodenoscopy, EoS = Eosinophil, TFED = Two-Food Elimination Diet, FFED = Four-Food Elimination Diet, SFED = Six-Food Elimination Diet [26][27][28][29][30][31] Endoscopic biopsy is usually performed to check for the histologic response after the elimination of a food group when patients demonstrate a histologic response to monitor whether the disease will reoccur after the sequential reintroduction of that food group. Though there are no standardized approaches to food reintroduction and follow-up endoscopy, endoscopy is usually performed after reintroducing one to two foods [1,20,28].…”