What Are Some Treatment Options for Eosinophilic Esophagitis

Medical Treatment Options For EoE

The best treatment of eosinophilic esophagitis is to use gentle esophageal dilatation and medications. The goal of treatment is to relieve symptoms of dysphagia.

For decades, gastroenterologists have been treating patients as individuals with dysphagia due to esophageal strictures and Schatzki rings from esophagitis in precisely the same manner. Dilatation involves physically stretching the strictures or fracturing of their strictures or fracturing the rings, thus allowing freer passage of food. Fracturing or stretching of those strictures or rings can be performed using endoscopes, long and elastic dilators of different diameters or using balloons inserted by means through a channel in the endoscope. The bows are positioned in the amount of ring or the stricture and then inflated to break the ring of the stricture.

While esophageal dilatation has been an effective and usually safe therapy, doctors have discovered that some patients with eosinophilic esophagitis grow tears in the esophageal lining that may lead to acute chest pain following dilation. Rare cases of esophageal perforations (tears through the entire esophageal wall) also have been reported. Esophageal perforations are a serious complication that can lead to infections in the chest in some cases. Although physicians may still utilize dilatation to take care of dysphagia from esophagitis, they are more inclined to utilize dilators that are smaller and less use less pressure when they are treating rings and esophageal strictures. Additionally, doctors also are using medications to treat dysphagia from eosinophilic esophagitis and utilizing dilation when drugs fail.

Some Medication Options

The medications primarily used in treating eosinophilic esophagitis are fluticasone propionate (Flovent) and proton pump inhibitors (Protonix, Nexium, Aciphex, Prevacid, Prilosec, Dexilant, and Zegerid).

Their use is limited by the side effects of steroids although steroids are effective in treating eosinophilic esophagitis. One new oral steroid that is being analyzed is budesonide, an orally-administered steroid that's absorbed into the body but is quickly destroyed, leading to fewer serious side effects. The current treatment of eosinophilic esophagitis is with consumed (not inhaled) fluticasone propionate. Fluticasone propionate is a synthetic (man-made) steroid that's related to the naturally occurring steroid hormone, cortisol or hydrocortisone, produced by the adrenal glands. These steroids have powerful anti-inflammatory activities. When employed as an inhaler, fluticasone propionate reduces inflammation in the airways of individuals using asthma, thereby relieving wheezing and breathing difficulties. It has been demonstrated to decrease the eosinophils and also alleviate dysphagia in patients with eosinophilic esophagitis, once propionate is swallowed.

In treating eosinophilic esophagitis, fluticasone propionate is treated using the exact same inhaler as for asthma but without the usual spacer in the inhaler. The elimination of the spacer causes the fluticasone propionate to deposit in the mouth rather than enter the lungs. The fluticasone propionate that deposits in the mouth is consumed with a little bit of water twice daily for many weeks. Patients are instructed not to eat or drink for 2 hours following each treatment. Progress in dysphagia is prompt, within months or days. Most patients develop symptoms after quitting treatment need treatment and/or continuous retreatment.

Little of the fluticasone propionate is absorbed into the body when used in low doses and so side effects are minimal. 1 possible side effect is thrush (infection of the throat and mouth by a parasite, candida), which can be relatively simple to deal with. Sufficient fluticasone propionate could be absorbed to cause unwanted effects throughout the body when higher doses are used for a prolonged period. Unwanted effects of high doses of fluticasone propionate are the side effects of oral steroids such as prednisone and cortisone.

Proton pump inhibitors, pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), lansoprazole (Prevacid), dexlansoprazole (Dexilant), and omeprazole (for instance, Prilosec, Zegerid) reduce production of acid by the stomach. They are quite safe and effective remedy for the symptoms of acid reflux and esophagitis. Pump inhibitors are frequently used by physicians for curing eosinophilic esophagitis since esophagitis in certain patients may aggravate with esophagitis. Proton pump inhibitors do not deal with the underlying esophagitis; however, and treatment with another steroid or fluticasone is required also.

Elimination Diet

The leading idea about the reason for eosinophilic esophagitis is the fact that it signifies an allergy to some protein found in food. Evidence has accumulated in children that diets which remove the allergy-causing food could result in reversal of their esophagitis and disappearance of their eosinophils. Evidence that is similar is currently accumulating in patients. Doctors have used elimination diets to define exactly what the allergy-inciting foods may be.

There are several methods in which elimination diets can be attempted and your first step is to get a food sensitivity test done. Here are some other options:

  • The first would be to perform skin and blood tests searching for specific foods that might be causing the allergy and then eliminating these foods from the diet.
  • The next is to remove the significant groups of food to that allergy is most common, especially milk protein, soy, peanut/tree nuts, eggs, wheat, and fish.

None of those elimination diets are simple for patients to follow, especially kids or for physicians, and each has its own advantages and disadvantages. Nevertheless, if one or two foods can be identified that are responsible for the allergy, a near-normal diet can be resumed, and the need for medications can be eliminated over time.

Elimination Diet Video Resources