Eosinophilic esophagitis medical therapy
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Eosinophilic Esophagitis Microchapters |
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Differentiating Eosinophilic Esophagitis from other Diseases |
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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 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 88–440 mcg/day for children or 880–1760 mcg/day for adults or budesonide 1 mg/day for children or 2 mg/day for adults) may be used as the first-line pharmacologic therapy. Patients without symptomatic and histologic improvement after topical steroids may benefit from a longer course or higher doses of topical steroids, systemic steroids with prednisone, elimination diet, or esophageal dilation.[1] 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.
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:
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