Eosinophilic esophagitis medical therapy
Eosinophilic Esophagitis Microchapters
Eosinophilic esophagitis medical therapy On the Web
American Roentgen Ray Society Images of Eosinophilic esophagitis medical therapy
The optimal treatment of eosinophilic esophagitis remains uncertain. An eight-week course of therapy with topical corticosteroids (fluticasone or budesonide) may be used as the first-line pharmacologic therapy. Allergen elimination usually leads to improvement in dysphagia and reduction of eosinophil infiltration. Esophageal dilation of is generally reserved for refractory cases with esophageal stricture.
- The medical therapy of the EoE is as follows:
- The optimal treatment of eosinophilic esophagitis remains uncertain.
- The endpoints of therapy of eosinophilic esophagitis include improvements in clinical symptoms and esophageal eosinophilic inflammation.
- An eight-week course of therapy with topical corticosteroids fluticasone or budesonide may be used as the first-line pharmacologic therapy.
- Patients without symptomatic and histologic improvement after topical steroids may be indicated for
- Oropharyngeal and esophageal candidiasis have been reported in patients treated with oral fluticasone.
- Evaluation by an allergist for coexisting atopic disorders, food, and environmental allergens is advisable.
- Allergen elimination usually leads to improvement in dysphagia and reduction of eosinophil infiltration.
- Graduated dilation of esophageal stricture should be performed with caution to minimize the risk of iatrogenic perforation.
- The dietary strategies are as follows:
- Elemental diet- highly effective in both adults and children, but it is limited by patient tolerability.
- Empiric six-food elimination diet (SFED)- the most common foods that trigger EoE are: soy, fish, cow milk, nuts, eggs, wheat.
- Limited diet driven by allergy testing and patient history- The allergy testing directs diet approach, although effective in the pediatric group has only moderate success in adults.
- The goal of dietary therapy is identification and removal of food antigens and consequently remove the sensitization.
- Diet therapy gives patients an alternative to control their disease, many patients find the idea of managing their sickness by means of removing the nutritional trigger more appealing than taking a drug to counteract the downstream inflammatory response.
- It is far vital to emphasize that the stern dietary elimination of multiple foods is only for a limited time but the long-term goal is the identify and remove the triggering dietary elements.
- Prolonged deviation from the elimination diet can be managed via the intermittent use of quick courses of topical steroids.
- Dilation is considered safe and effective in relieving the dysphagia in patients with EoE.
- Esophageal dilation has a very good acceptance in patients and it does not influence eosinophilic inflammation.
- Patients with esophageal strictures can be treated by esophageal dilation.
- Esophageal dilation is contraindicated in patients with endoscopic signs of acute inflammation.
- Postprocedural pain is very common in patients with esophageal dilation.
- The use of swallowed topical steroids before dilation reduces the risk of endoscopic complications such as bleeding, perforation, and postprocedural pain.
- Delaying the procedure in patients with strictures can lead to acute food bolus impactions.
- Food impactions should be dealt with carefully as they can cause spontaneous esophageal perforation and procedure-induced complications.
- Dellon, Evan S.; Gonsalves, Nirmala; Hirano, Ikuo; Furuta, Glenn T.; Liacouras, Chris A.; Katzka, David A.; American College of Gastroenterology (2013-05). "ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)". The American Journal of Gastroenterology. 108 (5): 679–692, quiz 693. doi:10.1038/ajg.2013.71. ISSN 1572-0241. PMID 23567357. Check date values in:
- de Vernejoul P, Mestan J, Delaloye B (1971). "The application of radiocardiography in measuring pulmonary pressures and resistances". Helv Med Acta. 36 (1): 67–78. PMID 4946566.
- Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE (2005). "Eosinophilic esophagitis: a 10-year experience in 381 children". Clin. Gastroenterol. Hepatol. 3 (12): 1198–206. PMID 16361045.
- Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR (2006). "Eosinophilic esophagitis in adults--no clinical relevance of wheat and rye sensitizations". Allergy. 61 (12): 1480–3. doi:10.1111/j.1398-9995.2006.01224.x. PMID 17073881.
- Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA (2003). "Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents". Am. J. Gastroenterol. 98 (4): 777–82. doi:10.1111/j.1572-0241.2003.07390.x. PMID 12738455.
- Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, Melin-Aldana H, Li BU (2006). "Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis". Clin. Gastroenterol. Hepatol. 4 (9): 1097–102. doi:10.1016/j.cgh.2006.05.026. PMID 16860614.
- Lucendo AJ, Arias Á, González-Cervera J, Yagüe-Compadre JL, Guagnozzi D, Angueira T, Jiménez-Contreras S, González-Castillo S, Rodríguez-Domíngez B, De Rezende LC, Tenias JM (2013). "Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: a prospective study on the food cause of the disease". J. Allergy Clin. Immunol. 131 (3): 797–804. doi:10.1016/j.jaci.2012.12.664. PMID 23375693.
- Morrey BF, Tanaka S, An KN (1991). "Valgus stability of the elbow. A definition of primary and secondary constraints". Clin. Orthop. Relat. Res. (265): 187–95. PMID 2009657.
- Parkhouse RM, Guarnotta G (1978). "Rapid binding test for detection of alloantibodies to lymphocyte surface antigens". Curr. Top. Microbiol. Immunol. 81: 142. PMID 357091.
- Ukleja A, Shiroky J, Agarwal A, Allende D (2014). "Esophageal dilations in eosinophilic esophagitis: a single center experience". World J. Gastroenterol. 20 (28): 9549–55. doi:10.3748/wjg.v20.i28.9549. PMC 4110588. PMID 25071351.
- Richter JE (2015). "Esophageal dilation in eosinophilic esophagitis". Best Pract Res Clin Gastroenterol. 29 (5): 815–828. doi:10.1016/j.bpg.2015.06.015. PMID 26552780.
- Schoepfer A (2014). "Treatment of eosinophilic esophagitis by dilation". Dig Dis. 32 (1–2): 130–3. doi:10.1159/000357091. PMID 24603396.