Eosinophilic esophagitis medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*The medical therapy of the EoE is as follows:<ref>{{Cite journal| doi = 10.1038/ajg.2013.71| issn = 1572-0241| volume = 108| issue = 5| pages = 679–692; quiz 693| last1 = Dellon| first1 = Evan S.| last2 = Gonsalves| first2 = Nirmala| last3 = Hirano| first3 = Ikuo| last4 = Furuta| first4 = Glenn T.| last5 = Liacouras| first5 = Chris A.| last6 = Katzka| first6 = David A.| last7 = American College of Gastroenterology| title = ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)| journal = The American Journal of Gastroenterology| date = 2013-05| pmid = 23567357}}</ref><ref name="pmid4946566">{{cite journal |vauthors=de Vernejoul P, Mestan J, Delaloye B |title=The application of radiocardiography in measuring pulmonary pressures and resistances |journal=Helv Med Acta |volume=36 |issue=1 |pages=67–78 |year=1971 |pmid=4946566 |doi= |url=}}</ref><ref name="pmid16361045">{{cite journal |vauthors=Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |pmid=16361045 |doi= |url=}}</ref><ref name="pmid17073881">{{cite journal |vauthors=Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR |title=Eosinophilic esophagitis in adults--no clinical relevance of wheat and rye sensitizations |journal=Allergy |volume=61 |issue=12 |pages=1480–3 |year=2006 |pmid=17073881 |doi=10.1111/j.1398-9995.2006.01224.x |url=}}</ref><ref name="pmid16361045">{{cite journal |vauthors=Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |pmid=16361045 |doi= |url=}}</ref><ref name="pmid12738455">{{cite journal |vauthors=Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA |title=Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents |journal=Am. J. Gastroenterol. |volume=98 |issue=4 |pages=777–82 |year=2003 |pmid=12738455 |doi=10.1111/j.1572-0241.2003.07390.x |url=}}</ref><ref name="pmid16860614">{{cite journal |vauthors=Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, Melin-Aldana H, Li BU |title=Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=9 |pages=1097–102 |year=2006 |pmid=16860614 |doi=10.1016/j.cgh.2006.05.026 |url=}}</ref><ref name="pmid23375693">{{cite journal |vauthors=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 |title=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 |journal=J. Allergy Clin. Immunol. |volume=131 |issue=3 |pages=797–804 |year=2013 |pmid=23375693 |doi=10.1016/j.jaci.2012.12.664 |url=}}</ref><ref name="pmid2009657">{{cite journal |vauthors=Morrey BF, Tanaka S, An KN |title=Valgus stability of the elbow. A definition of primary and secondary constraints |journal=Clin. Orthop. Relat. Res. |volume= |issue=265 |pages=187–95 |year=1991 |pmid=2009657 |doi= |url=}}</ref><ref name="pmid357091">{{cite journal |vauthors=Parkhouse RM, Guarnotta G |title=Rapid binding test for detection of alloantibodies to lymphocyte surface antigens |journal=Curr. Top. Microbiol. Immunol. |volume=81 |issue= |pages=142 |year=1978 |pmid=357091 |doi= |url=}}</ref> | *The medical therapy of the EoE is as follows:<ref>{{Cite journal| doi = 10.1038/ajg.2013.71| issn = 1572-0241| volume = 108| issue = 5| pages = 679–692; quiz 693| last1 = Dellon| first1 = Evan S.| last2 = Gonsalves| first2 = Nirmala| last3 = Hirano| first3 = Ikuo| last4 = Furuta| first4 = Glenn T.| last5 = Liacouras| first5 = Chris A.| last6 = Katzka| first6 = David A.| last7 = American College of Gastroenterology| title = ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE)| journal = The American Journal of Gastroenterology| date = 2013-05| pmid = 23567357}}</ref><ref name="pmid4946566">{{cite journal |vauthors=de Vernejoul P, Mestan J, Delaloye B |title=The application of radiocardiography in measuring pulmonary pressures and resistances |journal=Helv Med Acta |volume=36 |issue=1 |pages=67–78 |year=1971 |pmid=4946566 |doi= |url=}}</ref><ref name="pmid16361045">{{cite journal |vauthors=Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |pmid=16361045 |doi= |url=}}</ref><ref name="pmid17073881">{{cite journal |vauthors=Simon D, Straumann A, Wenk A, Spichtin H, Simon HU, Braathen LR |title=Eosinophilic esophagitis in adults--no clinical relevance of wheat and rye sensitizations |journal=Allergy |volume=61 |issue=12 |pages=1480–3 |year=2006 |pmid=17073881 |doi=10.1111/j.1398-9995.2006.01224.x |url=}}</ref><ref name="pmid16361045">{{cite journal |vauthors=Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE |title=Eosinophilic esophagitis: a 10-year experience in 381 children |journal=Clin. Gastroenterol. Hepatol. |volume=3 |issue=12 |pages=1198–206 |year=2005 |pmid=16361045 |doi= |url=}}</ref><ref name="pmid12738455">{{cite journal |vauthors=Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA |title=Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents |journal=Am. J. Gastroenterol. |volume=98 |issue=4 |pages=777–82 |year=2003 |pmid=12738455 |doi=10.1111/j.1572-0241.2003.07390.x |url=}}</ref><ref name="pmid16860614">{{cite journal |vauthors=Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, Melin-Aldana H, Li BU |title=Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis |journal=Clin. Gastroenterol. Hepatol. |volume=4 |issue=9 |pages=1097–102 |year=2006 |pmid=16860614 |doi=10.1016/j.cgh.2006.05.026 |url=}}</ref><ref name="pmid23375693">{{cite journal |vauthors=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 |title=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 |journal=J. Allergy Clin. Immunol. |volume=131 |issue=3 |pages=797–804 |year=2013 |pmid=23375693 |doi=10.1016/j.jaci.2012.12.664 |url=}}</ref><ref name="pmid2009657">{{cite journal |vauthors=Morrey BF, Tanaka S, An KN |title=Valgus stability of the elbow. A definition of primary and secondary constraints |journal=Clin. Orthop. Relat. Res. |volume= |issue=265 |pages=187–95 |year=1991 |pmid=2009657 |doi= |url=}}</ref><ref name="pmid357091">{{cite journal |vauthors=Parkhouse RM, Guarnotta G |title=Rapid binding test for detection of alloantibodies to lymphocyte surface antigens |journal=Curr. Top. Microbiol. Immunol. |volume=81 |issue= |pages=142 |year=1978 |pmid=357091 |doi= |url=}}</ref><ref name="pmid25071351">{{cite journal |vauthors=Ukleja A, Shiroky J, Agarwal A, Allende D |title=Esophageal dilations in eosinophilic esophagitis: a single center experience |journal=World J. Gastroenterol. |volume=20 |issue=28 |pages=9549–55 |year=2014 |pmid=25071351 |pmc=4110588 |doi=10.3748/wjg.v20.i28.9549 |url=}}</ref><ref name="pmid26552780">{{cite journal |vauthors=Richter JE |title=Esophageal dilation in eosinophilic esophagitis |journal=Best Pract Res Clin Gastroenterol |volume=29 |issue=5 |pages=815–828 |year=2015 |pmid=26552780 |doi=10.1016/j.bpg.2015.06.015 |url=}}</ref><ref name="pmid24603396">{{cite journal |vauthors=Schoepfer A |title=Treatment of eosinophilic esophagitis by dilation |journal=Dig Dis |volume=32 |issue=1-2 |pages=130–3 |year=2014 |pmid=24603396 |doi=10.1159/000357091 |url=}}</ref> | ||
*The optimal treatment of [[eosinophilic esophagitis]] remains uncertain. | *The optimal treatment of [[eosinophilic esophagitis]] remains uncertain. | ||
'''Steroid Therapy''' | '''Steroid Therapy''' | ||
Revision as of 22:54, 17 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.
Medical Therapy
- The medical therapy of the EoE is as follows:[1][2][3][4][3][5][6][7][8][9][10][11][12]
- The optimal treatment of eosinophilic esophagitis remains uncertain.
Steroid Therapy
- 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
- Children
- 88–440 mcg/day fluticasone
- 1 mg/day budesonide
- Adults
- 880–1760 mcg/day fluticasone
- 2 mg/day budesonide may be used as the first-line pharmacologic therapy.
- Patients without symptomatic and histologic improvement after topical steroids
- Long course or higher doses of topical steroids
- Systemic steroids with prednisone
- Dietary elimination
- Endoscopic dilation
- Oropharyngeal and esophageal candidiasis have been reported in patients treated with oral fluticasone,
- Evaluation by an allergist for coexisting atopic disorders and 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.
Dietary Modification
- 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)- six most common foods that trigger EoE are as follows: soy, fish, cow milk, nuts, eggs, wheat.
- Limited diet driven by allergy testing and patient history- The allergy testing directed 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 remedying their sickness by means of getting removing a nutritional trigger greater 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 intermittent use of quick courses of topical steroids.
Esophageal dilation
- Dilation is considered safe and effective in relieving the dysphagia in patients with Eosinophilic esophagitis.
- 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 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 should be dealt carefully as they can cause spontaneous esophageal perforation, procedure-induced complications.
References
- ↑ 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:
|date=(help) - ↑ 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.
- ↑ 3.0 3.1 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.