Materiały źródłowe

• #1 Treatment of eosinophilic esophagitis (EoE) – UpToDate

  https://www.uptodate.com/contents/treatment-of-eosinophilic-esophagitis-eoe

  Treatment of eosinophilic esophagitis (EoE) […] The management of EoE includes dietary, pharmacologic, and endoscopic interventions. […] Commonly used treatments include dietary therapy, acid suppression, and topical glucocorticoids. […] This topic will review the pharmacologic and endoscopic treatment of EoE.

• #2 Recent advances in the treatment of eosinophilic esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10530275/

  Eosinophilic esophagitis (EoE) is an increasingly common inflammatory allergic disease of the esophagus characterized by esophageal eosinophilia and symptoms of esophageal dysfunction. The therapeutic landscape has rapidly evolved for this emerging type 2 inflammatory disorder. […] After the diagnosis of EoE is established or the status of active EoE is confirmed, treatment is necessary to alleviate symptoms. Moreover, as touched on above, treatment of ongoing, active inflammation is necessary to prevent fibrotic complications including strictures and narrowing. Goals of treatment in EoE include inducing histologic remission (defined as less than 15 eosinophils per hpf) and relieving symptoms of esophageal dysfunction. Consequently, these two goals are often co-primary outcomes in the evaluation of new therapies.

• #3 Recent advances in the treatment of eosinophilic esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10530275/

  Eosinophilic esophagitis (EoE) is an increasingly common inflammatory allergic disease of the esophagus characterized by esophageal eosinophilia and symptoms of esophageal dysfunction. The therapeutic landscape has rapidly evolved for this emerging type 2 inflammatory disorder. […] After the diagnosis of EoE is established or the status of active EoE is confirmed, treatment is necessary to alleviate symptoms. Moreover, as touched on above, treatment of ongoing, active inflammation is necessary to prevent fibrotic complications including strictures and narrowing. Goals of treatment in EoE include inducing histologic remission (defined as less than 15 eosinophils per hpf) and relieving symptoms of esophageal dysfunction. Consequently, these two goals are often co-primary outcomes in the evaluation of new therapies.

• #4

  https://link.springer.com/article/10.1007/s40629-023-00265-6

  Eosinophilic esophagitis (EoE) has seen significant progress in its understanding, including its definition, clinical presentation, diagnosis, and treatment. […] Therapeutic strategies for EoE aim to alleviate symptoms, induce and maintain remission, and prevent complications. These strategies include dietary modifications, pharmacotherapy, and endoscopic interventions. […] Treatment choice depends on disease severity, patient preferences, and comorbidities. […] Current European and US guidelines recommend initiating an induction therapy upon the detection of active EoE, with the goal of achieving clinical and histological remission. […] The therapeutic management of EoE is often referred to as the three Ds, which stand for drugs, dietary interventions, and endoscopic therapy (dilation).

• #5 Treatment Guidelines | Consortium of Eosinophilic Gastrointestinal Disease Researchers

  https://cegir.rarediseasesnetwork.org/resources/researchers-clinicians/treatment-guidelines

  The following is a summary of currently accepted therapies in eosinophilic esophagitis, which as noted above has been the best studied of these diseases. These treatments have been reviewed in the process of developing consensus statements on the diagnosis and management of eosinophilic esophagitis (EoE). […] The currently accepted EoE therapies are categorized as diet, drugs, and dilation (3 Ds). The first line of treatment in a patient with uncomplicated EoE can be either a dietary or a drug-based approach. The goal of these approaches are to induce and maintain remission of EoE to minimize the risk of potential fibrostenotic complications. […] The rationale for dietary intervention is to control the eosinophilic inflammation in the esophagus by eliminating food-allergen(s) presumed to be causing EoE and avoiding medications and their related side effects.

• #6 Eosinophilic esophagitis: Current concepts in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v25/i32/4598.htm

  Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology (genetic and environmental) that affects both pediatric and adult patients. […] Currently, the 3 Ds (Drugs, Diet, and Dilation) are considered the fundamental components of treatment. The first 2 components, which involve the use of proton pump inhibitors, corticosteroids, immunosuppressants and empirical diets or guided food elimination based on allergy tests, are more useful in the initial phases, whereas endoscopic dilation is reserved for esophageal strictures. […] The treatment of EoE revolves around controlling causative factors and the Th2 response, which is altered in the same way as in allergic respiratory diseases for which Drugs are the main treatment option; in addition, Diet modifications are used to control interacting environmental factors, and endoscopic Dilation is used for the management of endoscopic complications.

• #7 The Role of Medications in the Management of Eosinophilic Esophagitis (EoE): A Review of Current Treatment Options – Canadian Digestive Health Foundation

  https://cdhf.ca/en/the-role-of-medications-in-the-management-of-eosinophilic-esophagitis-eoe-a-review-of-current-treatment-options/

  For many patients, proton pump inhibitor (PPI) therapy will be the first medication prescribed for the treatment of their eosinophilic esophagitis (EoE). These medications, which are very effective acid blockers, have been used for decades to treat gastro-esophageal reflux disease. While historically, these prescription antacids were used to distinguish reflux disease from EoE, as time went on, it was discovered that these medications work in a way that is beyond blocking acid and may block the recruitment of eosinophils. In a proportion (as many as half) of patients with eosinophilic esophagitis, these medications improve the eosinophilic inflammation in the esophagus. […] Swallowed topical corticosteroids act on the surface of the esophageal lining and are very effective at settling down the inflammation seen in EoE. These medications are similar or even borrowed from asthma treatment, but they are administered differently when treating EoE with the idea of delivering the medication directly to the esophagus. The two main types of corticosteroids used for EoE treatment are fluticasone and budesonide.

• #8 Eosinophilic Esophagitis

  https://www.aaaai.org/conditions-treatments/related-conditions/eosinophilic-esophagitis

  Eliminating the major food allergens from the diet is considered an acceptable treatment of EoE. The foods excluded usually include foods such as dairy, wheat, egg, and soy. These diets have been shown to be very helpful in treating EoE, although they can be very difficult to follow, especially without the help of a dietitian with experience in dealing with EoE. Foods are typically added back one at a time with follow up endoscopies to help determine which specific foods are causing EoE. […] In this strict elimination diet, all sources of allergens are removed from the diet. The patient receives their nutrition from an amino acid formula alone or sometimes while allowing one to two simple foods chosen based on their low likelihood to trigger EoE. […] Dupixent (dupilumab) is one of only two medical therapies to date that has been approved by the Food and Drug Administration (FDA) to treat eosinophilic esophagitis. It has recently been approved in patients 1 year of age and older with certain weight restrictions. Dupixent is an injectable medication called a monoclonal antibody (or biologic) that is administered weekly. It reduces the inflammation associated with the disease and improves patients ability to swallow food. Other medications have been shown to reduce the number of eosinophils in the esophagus and improve symptoms. Proton pump inhibitors (PPIs), which reduce acid production in the stomach, have also been found to be able to reduce esophageal inflammation in some patients with EoE. Thus, PPIs are often used as a first treatment for EoE. However, not all patients respond to PPIs, and other forms of therapy such as swallowed topical corticosteroids or food elimination diets are considered.

• #9 Diagnosing and Managing Eosinophilic Esophagitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na58390/2025/02/11/diagnosing-and-managing-eosinophilic-esophagitis

  Updated guidelines by the American College of Gastroenterology offer a clear treatment algorithm. […] High-dose proton-pump inhibitors are effective in about half of patients, regardless of the presence or absence of reflux disease. […] Swallowed topical steroids (off-label generic fluticasone from metered-dose inhalers, off-label thickened budesonide from ampules used for nebulization, or U.S. FDA–approved budesonide oral suspension) have response rates of 60% to 90%. […] Empirical food avoidance is an option for patients who wish to avoid medications; food avoidance efficacy ranges from 40% to 70%. […] For patients who don’t respond to (or are unable to use) pharmacologic or dietary therapies, dupilumab (an anti–interleukin-4/13 monoclonal antibody) is FDA approved for EoE, with a remission rate of 60%.

• #10 Esophagitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/esophagitis/diagnosis-treatment/drc-20361264

  Treatment for eosinophilic esophagitis involves staying away from the allergen that trigger symptoms. Treatment also involves easing the allergic reaction with medicines. Medicines may include: […] Proton pump inhibitors. Your healthcare professional likely will first prescribe a proton pump inhibitor. You might take one such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec) or pantoprazole (Protonix). […] Steroids. Some studies show that swallowed steroids may act on the surface tissue of the esophagus to treat eosinophilic esophagitis. One steroid called budesonide (Eohilia) comes in a liquid form. Another steroid called fluticasone is sprayed into the mouth and then swallowed. […] Elimination and elemental diets. A reaction to a food allergen is likely the cause of eosinophilic esophagitis. So it may help to stop eating the food that seems to cause the allergy.

• #11 How to treat Eosinophilic Esophagitis (EoE) – Los Angeles Allergist

  https://allergylosangeles.com/allergy-blog/how-to-treat-eosinophilic-esophagitis-eoe/

  There can be many ways to treat eosinophilic esophagitis (EoE). […] The goal of treatment of eosinophilic esophagitis include histological remission (less than 15 eosinophils/hpf) and relieving symptoms of esophageal dysfunction. […] Here we discuss different treatment options for eosinophilic esophagitis: […] Proton pump inhibitors-this was one of the earliest treatment options for eosinophilic esophagitis. High doses of omeprazole (40mg twice daily) have shown to be helpful. […] Swallowed topical steroids-studies have shown response rates greater than 90% at 6 weeks. […] Prednisone-Prednisone can induce histological and symptomatic remission. […] Dietary Therapies-The 6 Food Elimination Diet target the removal of the most common food allergens. […] Dilation-the goal is to dilate 15-18 mm in patients with a clinically significant stricture.

• #12 Eosinophilic Oesophagitis | Doctor

  https://patient.info/doctor/eosinophilic-oesophagitis-pro

  Pharmacological treatment: Proton pump inhibitor therapy is effective in inducing histological and clinical remission in patients with eosinophilic oesophagitis. […] Proton pump inhibitor therapy should be given two times per day for at least 812 weeks prior to assessment of histological response, while on treatment. […] In patients who achieve histological response, proton pump inhibitor therapy appears effective in maintaining remission. […] Topical steroids are effective for inducing histological and clinical remission in eosinophilic oesophagitis. […] Clinical and histological relapse is high after withdrawal of topical steroid treatment, and following clinical review, maintenance treatment should be recommended. […] Systemic steroids are not recommended in eosinophilic oesophagitis.

• #13 Diagnosing and Managing Eosinophilic Esophagitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na58390/2025/02/11/diagnosing-and-managing-eosinophilic-esophagitis

  Updated guidelines by the American College of Gastroenterology offer a clear treatment algorithm. […] High-dose proton-pump inhibitors are effective in about half of patients, regardless of the presence or absence of reflux disease. […] Swallowed topical steroids (off-label generic fluticasone from metered-dose inhalers, off-label thickened budesonide from ampules used for nebulization, or U.S. FDA–approved budesonide oral suspension) have response rates of 60% to 90%. […] Empirical food avoidance is an option for patients who wish to avoid medications; food avoidance efficacy ranges from 40% to 70%. […] For patients who don’t respond to (or are unable to use) pharmacologic or dietary therapies, dupilumab (an anti–interleukin-4/13 monoclonal antibody) is FDA approved for EoE, with a remission rate of 60%.

• #14 Eosinophilic esophagitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203

  Eosinophilic esophagitis is considered a chronic relapsing disease, meaning that most people will require ongoing treatment to control their symptoms. Treatment will involve one or more of the following: […] Depending on your response to tests for food allergies, your health care provider may recommend that you stop eating certain foods. Cutting out some foods, such as dairy or wheat products, may help to relieve symptoms and reduce inflammation. Sometimes, it may be recommended to limit your diet even more. […] Your provider will likely first prescribe an acid blocker such as a PPI. This treatment is the easiest to use, but most people’s symptoms don’t improve. […] If you do not respond to the PPI, your provider will then likely prescribe a steroid, such as fluticasone or budesonide. This steroid is in a liquid form that is swallowed to treat eosinophilic esophagitis. This type of steroid is not absorbed into the bloodstream, so you are unlikely to have the typical side effects often associated with steroids.

• #15 Treatment of eosinophlic esophagitis with swallowed topical corticosteroids

  https://www.wjgnet.com/1007-9327/full/v26/i36/5395.htm

  Swallowed topical corticosteroids are a very effective and safe treatment option in eosinophilic esophagitis. Particularly, esophagus-targeted formulations can induce clinicopathological remission in the vast majority of patients. However, uncertainness regarding optimal dosage and duration of long-term treatment still exists. […] Proton pump inhibitors (PPIs), food-restriction-diets and swallowed topical corticosteroids (STCs) can be offered as first line anti-inflammatory therapy in EoE-patients. […] The effectiveness of STC-therapy in EoE has been shown in several studies in both children and adults. The most thoroughly evaluated topical corticosteroids are budesonide and fluticasone. Until today, seventeen randomized trials comprising nine placebo-controlled studies have been published.

• #16 New drug approvals are reshaping the landscape of Eosinophilic Esophagitis (EoE) treatment | Department of Medicine

  https://www.med.unc.edu/medicine/news/new-drug-approvals-are-reshaping-the-landscape-of-eosinophilic-esophagitis-eoe-treatment/

  The FDA has granted approval for two medications in the treatment of Eosinophilic Esophagitis (EoE) the first oral medication tailored for adults and the exclusive therapeutic option for children. […] His efforts, published in the journal Clinical Gastroenterology and Hepatology helped lead to the recent FDA approval of budesonide, the sole oral therapy designed for individuals aged 11 and older with EoE a significant milestone Dr. Dellon and colleagues have been diligently working towards for more than 10 years. […] Takeda Pharmaceuticals announced the twice-daily treatment will be available in single-dose stick packs (2mg/10mL) by the end of February. […] Additionally, the FDA recently approved dupilumab for pediatric patients aged one to eleven, marking a significant advancement in addressing this condition.

• #17 Esophagitis Treatment & Management: Approach Considerations, Reflux Esophagitis, Infectious Esophagitis

  https://emedicine.medscape.com/article/174223-treatment

  Dupilumab is a monoclonal antibody that inhibits interleukin-4 (IL-4) and IL-13 signaling by specifically binding to the IL-4R-alpha subunit shared by the IL-4 and IL-13 receptor complexes. […] It is approved by the FDA for treatment of eosinophilic esophagitis in adults and children aged 1 year and older who weigh at least 15 kg. […] Approval for adults and adolescents was based on the LIBERTY EoE TREET multicenter trial. […] Improvements in histologic, symptomatic, endoscopic, and molecular features of eosinophilic esophagitis observed after 24 weeks of weekly dupilumab treatment were maintained or continued to improve to week 52. […] Approval of dupilumab in children aged 1-11 years was supported by the Phase 3 EoE KIDS trial. […] Budesonide oral suspension (Eohilia), an esophageal-targeted formulation, received FDA approval in February 2024 for patients aged 11 years and older with EoE.

• #18 Promising Drugs for Eosinophilic Esophagitis Treatment in Pipeline

  https://www.delveinsight.com/blog/eosinophilic-esophagitis-treatment-outlook

  In December 2022, Sanofi and partner Regeneron announced that the European Medicines Agency’s Committee for Medicinal Products for Human Use (CHMP) had recommended approval of Dupixent (dupilumab) for the treatment of adults and adolescents with eosinophilic esophagitis, a chronic inflammatory disease. […] While there is no approved eosinophilic esophagitis treatment in the US, Europe had JORVEZA by Dr. Falk Pharma, which was approved in 2018. JORVEZA is indicated for eosinophilic esophagitis treatment in adults aged 18 and above, and it is an orodispersible tablet a more convenient and reliable way of delivering budesonide. […] Despite the favorable therapeutic effects of biologics, the approval of DUPIXENT, coupled with the promising biologics in the eosinophilic esophagitis pipeline, invites questions about their high costs. […] Eosinophilic esophagitis treatment currently consists of dietary, pharmacological, and endoscopic interventions. PPIs and corticosteroids are the mainstays of treatment in pharmacologic therapy.

• #19 Treatment Guidelines | Consortium of Eosinophilic Gastrointestinal Disease Researchers

  https://cegir.rarediseasesnetwork.org/resources/researchers-clinicians/treatment-guidelines

  The proton-pump inhibitors (PPIs) and topical corticosteroids (TCS) are currently the mainstays of the management of EoE. More recently, there has been immense interest in developing therapeutics targeting the specific molecules in the immunopathogenesis pathways to induce clinical improvement and histologic remission of EoE. […] Many consider PPIs as first-line therapy since this medication has been used for a long time for non-EoE indications. Additionally, PPIs well-studied in EoE and are readily available and relatively easy to administer. […] The TCS can not only alleviate the eosinophilic inflammation in the esophageal epithelium, but also lower epithelial cell apoptosis, decrease esophageal molecular remodeling, reduce the dilated intercellular spaces, and downregulate mast cell activity.

• #20 Treatment of eosinophlic esophagitis with swallowed topical corticosteroids

  https://www.wjgnet.com/1007-9327/full/v26/i36/5395.htm

  Generally, STC-treatment in EoE has been found to be well tolerated, with a good safety profile. Most common side effect is candida esophagitis which was estimated to occur in 8.7% of patients. […] STCs can be regarded as the medical treatment of choice for most EoE patients. Recommended standard regimes include either the use of budesonide 2 mg/daily or fluticasone 880-1760 g/daily in adults and budesonide 1mg/daily or fluticasone 88-440 g/daily in children, respectively.

• #21 What is EoE? – Children’s Hospital of Orange County

  https://choc.org/programs-services/eosinophilic-esophagitis/eoe/

  Are there side effects from topical steroids such as fluticasone and budesonide? The human mouth and throat contain many organisms including bacteria and yeast. Sometimes when medications like these are taken, small amounts of residue remain on the surface of the mouth and throat. This change can allow yeast organisms to multiply and cause soreness and trouble swallowing. This side effect can be eliminated by gargling with water and spitting after each use.

• #22 Eosinophilic esophagitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203

  The Food and Drug Administration (FDA) recently approved dupilumab (Dupixent) for treatment of adults and children 12 years and older with eosinophilic esophagitis. Dupilumab is a type of medicine known as a monoclonal antibody. It works to block the action of certain proteins in the body that cause inflammation. Dupilumab is given weekly via injection. […] If you experience severe narrowing, known as a stricture, of your esophagus, your provider may recommend dilation. Dilation, also called stretching, can help make swallowing easier. Dilation may be used if steroids are not helpful. Or dilation may be a choice to avoid ongoing use of medication.

• #23 DUPIXENT® (dupilumab) For Eosinophilic Esophagitis

  https://www.dupixent.com/eoe/

  DUPIXENT is the first and only FDA-approved treatment of its kind that helps manage eosinophilic esophagitis (EoE) in people aged 1 year and older who weigh at least 33 pounds (15 kg). […] DUPIXENT works differently; it is a biologic treatment option. […] DUPIXENT helps control an underlying inflammation that contributes to EoE symptoms. […] to treat adults and children 12 years of age and older, who weigh at least 88 pounds (40 kg), with eosinophilic esophagitis (EoE). It is not known if DUPIXENT is safe and effective in children with eosinophilic esophagitis under 12 years of age and who weigh at least 88 pounds (40 kg).

• #24 Eosinophilic Esophagitis Treatment for Patients | DUPIXENT® (dupilumab)

  https://www.dupixenthcp.com/eoe/

  DUPIXENT is indicated for the treatment of adult and pediatric patients aged 1 year and older, weighing at least 15 kg, with eosinophilic esophagitis (EoE).1 […] FDA-APPROVED in children as young as 1 year with EoE (15 kg)1 […] DUPIXENT MyWay is a patient support program that can help enable access to DUPIXENT and offers financial assistance for eligible patients, one-on-one nursing support, and more.

• #25

  https://www.eosnetwork.org/eoe-treatment

  Dupixent, also known as Dupilumab, is a pioneering biologic medication that targets the signalling pathways of two key cytokines, IL-4 and IL-13, which play a significant role in the inflammatory process. […] Clinical studies have demonstrated that Dupilumab can significantly alleviate symptoms associated with Eosinophilic Oesophagitis (EoE), such as dysphagia, and is generally well-tolerated by patients. […] For patients in the UK from Nov 2023, MHRA-approved Dupixent (Dupiliumab) as indicated for the treatment of eosinophilic oesophagitis in adults and adolescents 12 years and older, weighing at least 40 kg, who are inadequately controlled by, are intolerant to, or who are not candidates for conventional medicinal therapy proton pump inhibitor or oral topical steroids. […] The decision to use Dupixent (Dupilumab) as a first-line treatment varies by country.

• #26 Treatment Options for Patients with Eosinophilic Esophagitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na55648/2023/01/03/treatment-options-patients-with-eosinophilic-esophagitis

  In a randomized trial, 81 adolescents and adults with EoE were randomized to dupilumab (300 mg every 1 or 2 weeks) or placebo. After 24 weeks, dupilumab recipients were significantly more likely than placebo recipients to have histologic remission (60% vs. 5%). Interestingly, dysphagia symptom scores improved only in the group who received weekly dupilumab. […] For my patients with EoE, I begin with high-dose proton-pump inhibitors, which can provide histological and clinical remission in 50% to 60% of patients. I then offer the option of an elimination diet. Based on this study, avoiding milk and wheat (and possibly soy and egg) seems appropriate for adults initially, followed by 6FED for those who do not respond. If food avoidance is not effective or feasible, I use swallowed fluticasone with a metered dose inhaler or swallowed budesonide mixed in Splenda or honey (≈85% of children and ≈65% of adults respond to swallowed steroids). For patients with severe symptoms, esophageal dilation can provide temporary relief. For patients who don’t respond to swallowed steroids and elimination diets, dupilumab is the only current U.S. FDA-approved agent — dupilumab is even more attractive if the patient has concomitant severe eczema or asthma.

• #27 Diagnosing and Managing Eosinophilic Esophagitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na58390/2025/02/11/diagnosing-and-managing-eosinophilic-esophagitis

  Updated guidelines by the American College of Gastroenterology offer a clear treatment algorithm. […] High-dose proton-pump inhibitors are effective in about half of patients, regardless of the presence or absence of reflux disease. […] Swallowed topical steroids (off-label generic fluticasone from metered-dose inhalers, off-label thickened budesonide from ampules used for nebulization, or U.S. FDA–approved budesonide oral suspension) have response rates of 60% to 90%. […] Empirical food avoidance is an option for patients who wish to avoid medications; food avoidance efficacy ranges from 40% to 70%. […] For patients who don’t respond to (or are unable to use) pharmacologic or dietary therapies, dupilumab (an anti–interleukin-4/13 monoclonal antibody) is FDA approved for EoE, with a remission rate of 60%.

• #28 Consumer’s Guide to Biologics for Eosinophilic Esophagitis

  https://www.everydayhealth.com/eosinophilic-esophagitis/consumers-guide-to-biologics-for-eosinophilic-esophagitis/

  Guidelines state that a biologic can be prescribed for people with severe EoE and for people with EoE and another allergic condition, such as allergic rhinitis, asthma, or atopic dermatitis, because it blocks IL-4 and IL-13, the cytokines that play a role in triggering allergic reactions, says Cash. […] In other cases, a biologic may be used after other treatments, such as swallowed steroids and proton pump inhibitors, haven’t been effective, says Cash. […] We have years of experience [treating eosinophilic esophagitis] with those therapies, and we know they can work, says Cash. […] If you’ve recently been diagnosed with eosinophilic esophagitis or aren’t satisfied with your current treatment, you may want to consider taking a biologic.

• #29 Treatment Options for Patients with Eosinophilic Esophagitislogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na55648/2023/01/03/treatment-options-patients-with-eosinophilic-esophagitis

  In a randomized trial, 81 adolescents and adults with EoE were randomized to dupilumab (300 mg every 1 or 2 weeks) or placebo. After 24 weeks, dupilumab recipients were significantly more likely than placebo recipients to have histologic remission (60% vs. 5%). Interestingly, dysphagia symptom scores improved only in the group who received weekly dupilumab. […] For my patients with EoE, I begin with high-dose proton-pump inhibitors, which can provide histological and clinical remission in 50% to 60% of patients. I then offer the option of an elimination diet. Based on this study, avoiding milk and wheat (and possibly soy and egg) seems appropriate for adults initially, followed by 6FED for those who do not respond. If food avoidance is not effective or feasible, I use swallowed fluticasone with a metered dose inhaler or swallowed budesonide mixed in Splenda or honey (≈85% of children and ≈65% of adults respond to swallowed steroids). For patients with severe symptoms, esophageal dilation can provide temporary relief. For patients who don’t respond to swallowed steroids and elimination diets, dupilumab is the only current U.S. FDA-approved agent — dupilumab is even more attractive if the patient has concomitant severe eczema or asthma.

• #30 Eosinophilic esophagitis: Current concepts in diagnosis and treatment

  https://www.wjgnet.com/1007-9327/full/v25/i32/4598.htm

  EoE is a chronic inflammatory disease in which immune cells and cytokines are responsible for the inflammatory response and symptoms. […] Dietary modification is a nonpharmacological therapy for the management of EoE in adults and children, and it has been used because of the role that dietary antigens play in the pathogenesis of this disease. […] The benefits of the elemental diet were first described more than 2 decades ago. […] Given the limitations on the use of elemental diets in clinical practice, mainly because it requires an exclusive liquid formula with poor palatability, a retrospective study was performed in 2006 that included 60 children with EoE and compared the SFED (eliminating proteins from cow milk, soy, wheat, eggs, peanuts, and shellfish) with the elemental diet; after 6 wk, clinical and histological remission was observed in 74% of patients on the SFED, a result that was not inferior to the elemental diet but had better acceptance, adherence and cost. […] Bougie and balloon dilation is the only endoscopic treatment available for EoE. It should be performed in patients with persistent dysphagia resistant to medical treatment in whom remission of inflammation has been achieved and in patients with severe dysphagia and a history of food impaction.

• #31 Diagnosis and management of eosinophilic oesophagitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/diagnosis-and-management-of-eosinophilic-oesophagitis.html

  Dietary intervention involves identifying the specific food trigger(s) causing eosinophilic oesophagitis and avoiding consumption of that food in the future. […] Pharmacological treatment options have evolved over the past few years; current treatment options include swallowed topical corticosteroids and PPIs. No specific pharmacological treatment is considered first line; however, orodispersible budesonide tablets may be preferred because of their demonstrated high efficacy. […] Swallowed topical corticosteroids are the mainstay of treatment for eosinophilic oesophagitis and are generally continued lifelong in the absence of dietary intervention. […] Proton pump inhibitors (PPIs) are an appropriate treatment option and widely used in eosinophilic oesophagitis. […] Monoclonal antibodies that target the immune response and inflammation cascade are currently being investigated for eosinophilic oesophagitis.

• #32 Eosinophilic Esophagitis (EoE) – Allergy & Asthma Network

  https://allergyasthmanetwork.org/health-a-z/eosinophilic-esophagitis/

  There are several types of food elimination diets. […] 6-Food Elimination Diet (6FED). This eliminates cows milk, wheat, egg, soy, peanuts/tree nuts, and all seafood. It has shown to achieve remission in 74% of patients. […] 4-Food Elimination Diet (4FED). This eliminates cows milk, wheat, egg, and soy. It has shown to achieve remission in 64% of patients. […] 1-Food Elimination Diet (1FED). It eliminates cows milk. Studies results vary, but remission is typically between 43-65% of patients. […] Elimination diets should only be done under the guidance of a physician. Adhering to diet therapy is critical. It may be helpful to see a nutritionist or dietician to find replacement foods and ensure nutritional needs are met. […] In an elemental diet, people with EoE drink an amino acid formula and avoid protein. People often find it difficult to drink enough of the formula to get enough nutrition. They are evaluated after a week on the diet to see if they are drinking enough of the formula. If they are not getting enough, a nasogastric tube is given so the formula is delivered through the tube.

• #33 Management of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/management-of-eosinophilic-esophagitis/?srsltid=AfmBOoofZZibe5EIwYfWmEnMShBK_lYiabGa9DsY-xprfBFq1Mq7Mor6

  Dietary therapy has 3 main approaches: […] The elemental diet is a highly restrictive diet that consists of a liquid amino acid-based formula, which does not induce an allergic response. It has been shown to be more than 90% effective in causing histological remission of EoE symptoms. […] A six-food elimination diet (SFED) has been shown to cause a histologic remission rate of approximately 73% in children. […] Milk is now recognized as the most common food trigger and patients/families who opt for starting with an initial food elimination diet may focus on milk avoidance as a first approach. […] The overall effectiveness of empirical milk-only elimination diets has been reported to be 68% in one small study (n = 17). […] In consensus guidelines, the failure to respond to PPIs has been removed as a criterion for ruling out a diagnosis of EoE because some patients with EoE improve with PPI therapy.

• #34 Management of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/management-of-eosinophilic-esophagitis/?srsltid=AfmBOoofZZibe5EIwYfWmEnMShBK_lYiabGa9DsY-xprfBFq1Mq7Mor6

  Dietary therapy has 3 main approaches: […] The elemental diet is a highly restrictive diet that consists of a liquid amino acid-based formula, which does not induce an allergic response. It has been shown to be more than 90% effective in causing histological remission of EoE symptoms. […] A six-food elimination diet (SFED) has been shown to cause a histologic remission rate of approximately 73% in children. […] Milk is now recognized as the most common food trigger and patients/families who opt for starting with an initial food elimination diet may focus on milk avoidance as a first approach. […] The overall effectiveness of empirical milk-only elimination diets has been reported to be 68% in one small study (n = 17). […] In consensus guidelines, the failure to respond to PPIs has been removed as a criterion for ruling out a diagnosis of EoE because some patients with EoE improve with PPI therapy.

• #35 Eosinophilic Esophagitis (EoE) – Allergy & Asthma Network

  https://allergyasthmanetwork.org/health-a-z/eosinophilic-esophagitis/

  There are several types of food elimination diets. […] 6-Food Elimination Diet (6FED). This eliminates cows milk, wheat, egg, soy, peanuts/tree nuts, and all seafood. It has shown to achieve remission in 74% of patients. […] 4-Food Elimination Diet (4FED). This eliminates cows milk, wheat, egg, and soy. It has shown to achieve remission in 64% of patients. […] 1-Food Elimination Diet (1FED). It eliminates cows milk. Studies results vary, but remission is typically between 43-65% of patients. […] Elimination diets should only be done under the guidance of a physician. Adhering to diet therapy is critical. It may be helpful to see a nutritionist or dietician to find replacement foods and ensure nutritional needs are met. […] In an elemental diet, people with EoE drink an amino acid formula and avoid protein. People often find it difficult to drink enough of the formula to get enough nutrition. They are evaluated after a week on the diet to see if they are drinking enough of the formula. If they are not getting enough, a nasogastric tube is given so the formula is delivered through the tube.

• #36 Eosinophilic Esophagitis (EoE) – Allergy & Asthma Network

  https://allergyasthmanetwork.org/health-a-z/eosinophilic-esophagitis/

  There are several types of food elimination diets. […] 6-Food Elimination Diet (6FED). This eliminates cows milk, wheat, egg, soy, peanuts/tree nuts, and all seafood. It has shown to achieve remission in 74% of patients. […] 4-Food Elimination Diet (4FED). This eliminates cows milk, wheat, egg, and soy. It has shown to achieve remission in 64% of patients. […] 1-Food Elimination Diet (1FED). It eliminates cows milk. Studies results vary, but remission is typically between 43-65% of patients. […] Elimination diets should only be done under the guidance of a physician. Adhering to diet therapy is critical. It may be helpful to see a nutritionist or dietician to find replacement foods and ensure nutritional needs are met. […] In an elemental diet, people with EoE drink an amino acid formula and avoid protein. People often find it difficult to drink enough of the formula to get enough nutrition. They are evaluated after a week on the diet to see if they are drinking enough of the formula. If they are not getting enough, a nasogastric tube is given so the formula is delivered through the tube.

• #37 Eosinophilic Esophagitis (EoE) – Allergy & Asthma Network

  https://allergyasthmanetwork.org/health-a-z/eosinophilic-esophagitis/

  There are several types of food elimination diets. […] 6-Food Elimination Diet (6FED). This eliminates cows milk, wheat, egg, soy, peanuts/tree nuts, and all seafood. It has shown to achieve remission in 74% of patients. […] 4-Food Elimination Diet (4FED). This eliminates cows milk, wheat, egg, and soy. It has shown to achieve remission in 64% of patients. […] 1-Food Elimination Diet (1FED). It eliminates cows milk. Studies results vary, but remission is typically between 43-65% of patients. […] Elimination diets should only be done under the guidance of a physician. Adhering to diet therapy is critical. It may be helpful to see a nutritionist or dietician to find replacement foods and ensure nutritional needs are met. […] In an elemental diet, people with EoE drink an amino acid formula and avoid protein. People often find it difficult to drink enough of the formula to get enough nutrition. They are evaluated after a week on the diet to see if they are drinking enough of the formula. If they are not getting enough, a nasogastric tube is given so the formula is delivered through the tube.

• #38 Management of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/management-of-eosinophilic-esophagitis/?srsltid=AfmBOoofZZibe5EIwYfWmEnMShBK_lYiabGa9DsY-xprfBFq1Mq7Mor6

  Dietary therapy has 3 main approaches: […] The elemental diet is a highly restrictive diet that consists of a liquid amino acid-based formula, which does not induce an allergic response. It has been shown to be more than 90% effective in causing histological remission of EoE symptoms. […] A six-food elimination diet (SFED) has been shown to cause a histologic remission rate of approximately 73% in children. […] Milk is now recognized as the most common food trigger and patients/families who opt for starting with an initial food elimination diet may focus on milk avoidance as a first approach. […] The overall effectiveness of empirical milk-only elimination diets has been reported to be 68% in one small study (n = 17). […] In consensus guidelines, the failure to respond to PPIs has been removed as a criterion for ruling out a diagnosis of EoE because some patients with EoE improve with PPI therapy.

• #39

  https://www.eosnetwork.org/eoe-treatment

  Sometimes, the first dietary approach patients adopt is to avoid the types of food that stick. […] The common foods linked to the condition which might be excluded include: dairy, wheat, eggs, soya, rice, some fish and some vegetables (legumes). […] A recent study has found eliminating just animal milk from the diet of adults with EoE is as effective as the traditional 6FED (6 Food Elimination) diet therapy of eliminating six food groups, including animal milk, wheat, egg, soya, fish/shellfish and peanut/tree nuts. […] During this process, careful attention to nutrition with the help of a dietitian with expertise in EoE is essential to support a structured food exclusion and reintroduction and reassessment plan. […] Dilatation is an endoscopic procedure usually performed under sedation. […] It can be needed if the drugs/management is ineffective and would need to be complemented with a continuation of either a diet or drugs as above.

• #40 Management of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/management-of-eosinophilic-esophagitis/?srsltid=AfmBOoofZZibe5EIwYfWmEnMShBK_lYiabGa9DsY-xprfBFq1Mq7Mor6

  Dietary therapy has 3 main approaches: […] The elemental diet is a highly restrictive diet that consists of a liquid amino acid-based formula, which does not induce an allergic response. It has been shown to be more than 90% effective in causing histological remission of EoE symptoms. […] A six-food elimination diet (SFED) has been shown to cause a histologic remission rate of approximately 73% in children. […] Milk is now recognized as the most common food trigger and patients/families who opt for starting with an initial food elimination diet may focus on milk avoidance as a first approach. […] The overall effectiveness of empirical milk-only elimination diets has been reported to be 68% in one small study (n = 17). […] In consensus guidelines, the failure to respond to PPIs has been removed as a criterion for ruling out a diagnosis of EoE because some patients with EoE improve with PPI therapy.

• #41 Eosinophilic Esophagitis

  https://medlineplus.gov/eosinophilicesophagitis.html

  Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. […] If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

• #42 Eosinophilic esophagitis – Wikipedia

  https://en.wikipedia.org/wiki/Eosinophilic_esophagitis

  EoE treatment aims to control the symptoms by decreasing the number of eosinophils in the esophagus and, subsequently, reducing esophageal inflammation. Management consists of dietary, pharmacological, and endoscopic treatment. […] Dietary treatment can be effective, as allergies appear to play a role in developing EOE. Allergy testing is ineffective in predicting which foods drive the disease process. If no specific allergenic food or agent is present, a trial of the six-food elimination diet (SFED) can be pursued. […] Alternative options to SFED include the elemental diet, which is an amino acid-based diet. The elemental diet demonstrates a high rate of response (almost 90% in children, 70% in adults), with a rapid relief of symptoms associated with histological remission. This diet involves using amino acid-based liquid formulas for 4-6 wk, followed by the histological evaluation of response. If remission is achieved, foods are slowly reintroduced.

• #43 Eosinophilic Oesophagitis | Doctor

  https://patient.info/doctor/eosinophilic-oesophagitis-pro

  Eosinophilic oesophagitis treatment and management […] Diagnosing and treating eosinophilic oesophagitis effectively early in its natural history may prevent long-term complications of fibrosis and strictures requiring subsequent endoscopic intervention. […] In patients with food bolus obstruction, urgent referral to gastroenterology and an endoscopy on the next available endoscopy list, or as an immediate emergency is recommended, depending on clinical presentation. […] After initiation of therapy (dietary or pharmacological treatment), endoscopy with biopsy while on treatment is recommended to assess response, as symptoms may not always correlate with histological activity. Dietary treatment: Exclusive elemental diets have a limited role in eosinophilic oesophagitis, with high efficacy but low compliance rates and should be reserved for patients refractory to other treatments.

• #44 Eosinophilic Esophagitis (EoE) – Allergy & Asthma Network

  https://allergyasthmanetwork.org/health-a-z/eosinophilic-esophagitis/

  After 8-12 weeks on the formula, a repeat endoscopy with biopsy is done to look for disease remission. If the endoscopy shows remission, then foods are reintroduced one at a time or in small groups. People who use a nasogastric tube may transition to a gastronomy tube (g-tube). This allows for long-term nutritional supplements. […] As new foods are introduced, repeat endoscopies and biopsies are done every 8-12 weeks. This process can take 9-12 months or even several years. […] Elemental diets are very effective at achieving disease remission. Up to 95% of people who do elemental nutrition are able to achieve remission of EoE. But elemental diets can be challenging in terms of adherence. […] Since EoE is an inflammatory disease, the mainstay of therapy is to decrease inflammation in the esophageal tissue. Your doctor may prescribe:

• #45 Eosinophilic Oesophagitis | Doctor

  https://patient.info/doctor/eosinophilic-oesophagitis-pro

  Elimination diets are effective in achieving clinico-histological remission in both adults and paediatric patients with eosinophilic oesophagitis. […] A six food elimination diet results in higher histological remission rates than two or four food elimination diets, but is associated with lower compliance and an increased number of endoscopies. […] When undertaking a dietary restriction therapy for eosinophilic oesophagitis, support from an experienced dietitian throughout both the elimination and reintroduction process is strongly recommended. […] Allergy testing to foods (eg, skin prick, specific IgE and patch testing) is not recommended for choosing the type of dietary restriction therapy for eosinophilic oesophagitis. […] Combining elimination diets with pharmacological treatment is not routinely recommended but can be considered in cases of drug treatment failure.

• #46

  https://www.eosnetwork.org/eoe-treatment

  Sometimes, the first dietary approach patients adopt is to avoid the types of food that stick. […] The common foods linked to the condition which might be excluded include: dairy, wheat, eggs, soya, rice, some fish and some vegetables (legumes). […] A recent study has found eliminating just animal milk from the diet of adults with EoE is as effective as the traditional 6FED (6 Food Elimination) diet therapy of eliminating six food groups, including animal milk, wheat, egg, soya, fish/shellfish and peanut/tree nuts. […] During this process, careful attention to nutrition with the help of a dietitian with expertise in EoE is essential to support a structured food exclusion and reintroduction and reassessment plan. […] Dilatation is an endoscopic procedure usually performed under sedation. […] It can be needed if the drugs/management is ineffective and would need to be complemented with a continuation of either a diet or drugs as above.

• #47 Exploring Treatment Options for Eosinophilic Esophagitis

  https://www.mdpi.com/2036-7422/13/3/23

  Thus, EoE is often managed medically with proton-pump inhibitor therapy (PPIs), such as omeprazole and pantoprazole. […] While dietary and medical management may offer relief to some patients, many individuals with eosinophilic esophagitis experience symptoms secondary to chronic inflammation. […] Esophageal endoscopic dilation is a procedure that involves the use of inflatable balloon dilators passed through an endoscope or endoscopically placed wire guided bougienage techniques to mechanically expand strictured areas of the esophagus. […] While dietary, medical, and procedural management (steroids, PPIs, and dilation) result in symptomatic alleviation for many, newer treatment options continue to be investigated. […] Dupilumab is an IL-4 and IL-13 inhibitor that has previously demonstrated efficacy in other atopic conditions. A phase two study examining weekly subcutaneous injections of dupilumab found symptomatic improvement of dysphagia through increased distensibility of the esophagus with a resulting decrease in esophageal eosinophil counts. […] While these developing therapies are promising, dietary modification, corticosteroids, and PPIs remain mainstays of current therapy.

• #48 Eosinophilic Esophagitis: Management Guidelines from the AGA and JTF | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/0501/p573.html

  Topical steroids are more effective than proton pump inhibitors, resolving inflammation in two-thirds of patients, more than four times the placebo response. […] Oral steroid treatment demonstrates the same benefit as topical steroids, but with significant adverse effects in 40% of patients. […] Dysphagia in eosinophilic esophagitis is primarily caused by strictures secondary to inflammation. Endoscopic dilation leads to symptom improvement in 87% of patients.

• #49

  https://link.springer.com/article/10.1007/s40629-023-00265-6

  The initial evidence that dietary adherence can lead to remission comes from a pediatric study in which a strict amino acid-based diet was used, resulting in a clinical and histological remission rate of 80%. […] In a pediatric study in 2006, adherence to a 6 food elimination diet (SFED) demonstrated that 74% of children achieved histological and symptomatic remission. […] Endoscopic dilation, which can be performed using either through the scope balloons or wire-guided Savary bougies, is therefore a valuable treatment option. […] A meta-analysis of 525 adult EoE patients and a total of 992 dilations demonstrated clinical improvement in 75% of the patients.

• #50 A Look at the Updated ACG Eosinophilic Esophagitis Clinical Guidelines – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/eluri_feb2025/

  Dupilumab is an option for patients who are treatment-resistant to initial therapies, and also those with multiple atopic conditions. Dilation therapy is also available and can be used concomitantly with anti-inflammatory treatment. […] Maintenance therapy is necessary to prevent recurrence, and pediatric considerations include evaluation with esophagram in the setting of dysphagia and adjunctive feeding therapy for children with feeding dysfunction. […] Treatment involves shared decision-making, with first-line options including dietary elimination (starting with less restrictive approaches) or pharmacologic therapy (PPI or topical steroids). Endoscopic dilation is advised for strictures but should be combined with anti-inflammatory treatment. […] If pharmacologic therapy is chosen, then I typically start with topical steroids as the first line and employ a step-up approach. In patients with other atopic conditions in addition to EoE or those with a severe fibrostenotic phenotype, I may opt for dupilumab as the initial choice.

• #51 Eosinophilic esophagitis – Wikipedia

  https://en.wikipedia.org/wiki/Eosinophilic_esophagitis

  In patients diagnosed with EoE, a trial of proton-pump inhibitors (PPI), such as esomeprazole 20 mg to 40 mg oral daily or twice daily as a first-line therapy, is a reasonable option. […] Medical therapy for immune-mediated EoE primarily involves using corticosteroids. Systemic (oral) corticosteroids were one of the first treatment options shown to be effective in patients with EoE. Both clinical and histologic improvement have been noted in approximately 95% of EoE patients using systemic corticosteroids. […] Flexible upper endoscopy is recommended to remove impacted food in patients with food impaction. Dilation is deferred in EoE until patients are adequately treated with pharmacological or dietary therapy and the result of a response to therapy is available. The goals of therapy for treating EoE are to improve the patient’s symptoms and reduce the number of eosinophils on biopsy. This procedure is effective in 84% of people who require it.

• #52 Eosinophilic esophagitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/diagnosis-treatment/drc-20372203

  The Food and Drug Administration (FDA) recently approved dupilumab (Dupixent) for treatment of adults and children 12 years and older with eosinophilic esophagitis. Dupilumab is a type of medicine known as a monoclonal antibody. It works to block the action of certain proteins in the body that cause inflammation. Dupilumab is given weekly via injection. […] If you experience severe narrowing, known as a stricture, of your esophagus, your provider may recommend dilation. Dilation, also called stretching, can help make swallowing easier. Dilation may be used if steroids are not helpful. Or dilation may be a choice to avoid ongoing use of medication.

• #53 A Look at the Updated ACG Eosinophilic Esophagitis Clinical Guidelines – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/eluri_feb2025/

  This summary reviews Dellon E, Muir A, Katzka D, et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol 2025;120(1):31-59. […] What are the pharmacologic and non-pharmacologic therapies for disease management? […] Management: a) shared decision making to select first line dietary (empiric food elimination diet (FED) starting with 1-FED or 2-FED) or pharmacologic (PPI or topical steroids [Budesonide, Fluticasone]) therapy, Dupilumab for PPI non-responsive and step-up therapy; b) dilation therapy in addition to antiinflammatory treatment as needed; c) Monitor response to therapy, continue maintenance dietary or pharmacologic treatment. […] For treatment (Figure 1), high dose PPI therapy is advised along with counseling for rational for PPI use in EoE. For topical steroids, either budesonide (oral suspension or orodispersible tablet) or fluticasone can be used, and best administered after meals or before bedtime with nothing by mouth 30-60 minutes after.

• #54

  https://link.springer.com/article/10.1007/s40629-023-00265-6

  Eosinophilic esophagitis (EoE) has seen significant progress in its understanding, including its definition, clinical presentation, diagnosis, and treatment. […] Therapeutic strategies for EoE aim to alleviate symptoms, induce and maintain remission, and prevent complications. These strategies include dietary modifications, pharmacotherapy, and endoscopic interventions. […] Treatment choice depends on disease severity, patient preferences, and comorbidities. […] Current European and US guidelines recommend initiating an induction therapy upon the detection of active EoE, with the goal of achieving clinical and histological remission. […] The therapeutic management of EoE is often referred to as the three Ds, which stand for drugs, dietary interventions, and endoscopic therapy (dilation).

• #55 Management of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/management-of-eosinophilic-esophagitis/?srsltid=AfmBOoofZZibe5EIwYfWmEnMShBK_lYiabGa9DsY-xprfBFq1Mq7Mor6

  EoE is a chronic disease that requires long-term treatment. The goals of treatment are to: […] Treating children with EoE involves diet therapy and/or medical therapy. […] A multi-center, retrospective study drawing from a European database of patients with EoE (adults and children) demonstrated that clinical and histologic remission or response occurred in 82% of patients taking topical steroids, 69% of patients taking proton pump inhibitors, and 42% of patients on empirical elimination diets. […] The choice of treatment depends on the clinical picture, as well as family circumstance and preferences. […] Recent guidelines promote shared decision making and individualized approaches towards management. […] For many children, EoE is a non-IgE-mediated allergic disease, thus removal of relevant food allergens can cause remission of the disease.

• #56 Recent advances in the treatment of eosinophilic esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10530275/

  Dupilumab has recently become the first Federal Drug Administration (FDA)-approved treatment for eosinophilic esophagitis in May 2022. […] In a patient with newly-diagnosed eosinophilic esophagitis, we suggest that either PPI, topical corticosteroids, dietary therapy, or dupilumab could be used as first-line therapy.

• #57 How to treat Eosinophilic Esophagitis (EoE) – Los Angeles Allergist

  https://allergylosangeles.com/allergy-blog/how-to-treat-eosinophilic-esophagitis-eoe/

  There can be many ways to treat eosinophilic esophagitis (EoE). […] The goal of treatment of eosinophilic esophagitis include histological remission (less than 15 eosinophils/hpf) and relieving symptoms of esophageal dysfunction. […] Here we discuss different treatment options for eosinophilic esophagitis: […] Proton pump inhibitors-this was one of the earliest treatment options for eosinophilic esophagitis. High doses of omeprazole (40mg twice daily) have shown to be helpful. […] Swallowed topical steroids-studies have shown response rates greater than 90% at 6 weeks. […] Prednisone-Prednisone can induce histological and symptomatic remission. […] Dietary Therapies-The 6 Food Elimination Diet target the removal of the most common food allergens. […] Dilation-the goal is to dilate 15-18 mm in patients with a clinically significant stricture.

• #58 A Look at the Updated ACG Eosinophilic Esophagitis Clinical Guidelines – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/eluri_feb2025/

  Dupilumab is an option for patients who are treatment-resistant to initial therapies, and also those with multiple atopic conditions. Dilation therapy is also available and can be used concomitantly with anti-inflammatory treatment. […] Maintenance therapy is necessary to prevent recurrence, and pediatric considerations include evaluation with esophagram in the setting of dysphagia and adjunctive feeding therapy for children with feeding dysfunction. […] Treatment involves shared decision-making, with first-line options including dietary elimination (starting with less restrictive approaches) or pharmacologic therapy (PPI or topical steroids). Endoscopic dilation is advised for strictures but should be combined with anti-inflammatory treatment. […] If pharmacologic therapy is chosen, then I typically start with topical steroids as the first line and employ a step-up approach. In patients with other atopic conditions in addition to EoE or those with a severe fibrostenotic phenotype, I may opt for dupilumab as the initial choice.

• #59 Treatment of eosinophlic esophagitis with swallowed topical corticosteroids

  https://www.wjgnet.com/1007-9327/full/v26/i36/5395.htm

  The first experience with STCs was presented in 1998 in a paediatric case series of 11 children with EoE. Fluticasone was administered orally as spray from a metered-dose inhaler (age-adapted: 88-440 g twice a day). After 8 wk a clinical and histological response was observed in all patients. […] Budesonide aqueous solution was mixed with the sugar substitute sucralose, termed oral viscous budesonide (OVB), were reported in a small retrospective study on 20 children in 2007. Histological response was observed in 80% of patients and there was also a significant improvement of clinical symptoms and endoscopic findings, while no adverse events were recorded. […] EoE is considered a chronic progressing disease and most patients suffer from rapid relapse when therapy is stopped: […] STCs have been mainly successfully evaluated for short-term treatment of EoE but there is only limited data for long-term-treatment available.

• #60 Eosinophilic Oesophagitis | Doctor

  https://patient.info/doctor/eosinophilic-oesophagitis-pro

  Pharmacological treatment: Proton pump inhibitor therapy is effective in inducing histological and clinical remission in patients with eosinophilic oesophagitis. […] Proton pump inhibitor therapy should be given two times per day for at least 812 weeks prior to assessment of histological response, while on treatment. […] In patients who achieve histological response, proton pump inhibitor therapy appears effective in maintaining remission. […] Topical steroids are effective for inducing histological and clinical remission in eosinophilic oesophagitis. […] Clinical and histological relapse is high after withdrawal of topical steroid treatment, and following clinical review, maintenance treatment should be recommended. […] Systemic steroids are not recommended in eosinophilic oesophagitis.

• #61 Eosinophilic oesophagitis – A guide for primary care

  https://www.racgp.org.au/afp/2015/october/eosinophilic-oesophagitis-a-guide-for-primary-care

  Studies have consistently shown that both topical agents provide resolution of symptoms and eosinophilic inflammation in the majority of patients. […] Most patients are treated with an 8-week course of topical steroids and re-assessed. […] The disease almost always recurs in patients who discontinue treatment and it is generally agreed that ongoing therapy, whether dietary or pharmacological, is necessary. […] Oesophageal dilation is very effective in widening the oesophageal diameter and providing rapid relief of dysphagia. […] Avoiding allergens can often reverse the disease process of EoE. […] There is a role for acid suppression in patients with EoE, but it is not a curative measure. […] A suitable PPI regimen for adults with EoE is omeprazole 20 mg taken once daily before meal. […] EoE requires long-term multimodal care.

• #62 Eosinophilic Oesophagitis | Doctor

  https://patient.info/doctor/eosinophilic-oesophagitis-pro

  Eosinophilic oesophagitis treatment and management […] Diagnosing and treating eosinophilic oesophagitis effectively early in its natural history may prevent long-term complications of fibrosis and strictures requiring subsequent endoscopic intervention. […] In patients with food bolus obstruction, urgent referral to gastroenterology and an endoscopy on the next available endoscopy list, or as an immediate emergency is recommended, depending on clinical presentation. […] After initiation of therapy (dietary or pharmacological treatment), endoscopy with biopsy while on treatment is recommended to assess response, as symptoms may not always correlate with histological activity. Dietary treatment: Exclusive elemental diets have a limited role in eosinophilic oesophagitis, with high efficacy but low compliance rates and should be reserved for patients refractory to other treatments.

• #63 A Look at the Updated ACG Eosinophilic Esophagitis Clinical Guidelines – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/eluri_feb2025/

  For patients with initial response to treatment documented by histologic remission on an endoscopy performed 8-12 weeks later or 12-24 weeks for dupilumab, I will continue maintenance therapy with repeat endoscopy about a year or so later to ensure sustained remission in the absence of symptoms that would trigger an earlier exam such as a food impaction or need for dilation therapy.

• #64 Treatment Guidelines | Consortium of Eosinophilic Gastrointestinal Disease Researchers

  https://cegir.rarediseasesnetwork.org/resources/researchers-clinicians/treatment-guidelines

  With a greater understanding of the molecular mechanisms underlying EoE, limitations and side effects of existing therapeutic approaches, and advances in biotechnological methods, there is burgeoning interest in developing biologic therapies for EoE. […] Currently, repeated EGD with biopsies is required for diagnosing and monitoring EoE. EGD also has a crucial therapeutic role in the management of esophageal strictures, EFIs, and related complications, including esophageal perforation and bleeding. […] EoE is an increasingly prevalent, chronic, and progressive disease affecting all ages worldwide. Dietary elimination of food allergens, drugs including biologics, and esophageal dilation are the prevailing treatment options. However, new therapeutic targets are being discovered and this is promoting development of novel therapies for EoE.

• #65 Eosinophilic oesophagitis: improving diagnosis and therapy – reducing the burden of repeated endoscopy | Frontline Gastroenterology

  https://fg.bmj.com/content/13/e1/e51

  Current research on monoclonal antibodies using targeted anti-interleukin 4 receptor inhibitor (dupilumab) and anti-interleukin 5 receptor inhibitor (benralizumab) may introduce specific drugs targeted at cytokine blockade and other aspects of the Th2 inflammatory pathways in EoE. […] The indication for dilatation is stricture or for failure of symptoms to respond following BOT in a non-compliant oesophagus. […] It is well recognised that there is poor correlation between symptoms in patients with EoE and histological status. […] By using a therapy such as budesonide orodisperible tablets, that is effective in the majority (85%) of patients, the number of repeat endoscopies needed to find an effective therapy will be greatly reduced.

• #66 Eosinophilic Esophagitis | Symptoms & Treatment | ACAAI Public Website

  https://acaai.org/allergies/allergic-conditions/eosinophilic-esophagitis/

  Another possible treatment is the elemental diet, a special liquid or powder nutrition replacement taken for up to six weeks to allow your esophagus time to heal. […] Esophageal dilatation: If your esophagus gets too narrow, your doctor may recommend stretching it. […] Biologic therapy: Biologics are newer, targeted therapies that reduce inflammation. Biologics are provided by injection or IV (intravenous). The FDA approved dupilumab (Dupixent®) in 2022 as a treatment for EoE. Benralizumab (Fasenra®), another biologic, has orphan drug designation. The FDA may approve other biologics for EoE in the near future.

• #67 EoE Treatment: Recent Advances and Improved Outlook (VIDEO) | myEoEcenter

  https://eoe.myhealthteam.com/resources/eoe-treatment-recent-advances-and-improved-outlook

  Dr. Anisa Shaker, a gastroenterologist, talks about recent advances in the treatment of EoE. […] The top three advances that I am excited about in the treatment of our patients with eosinophilic esophagitis, or EoE, have to do with the medications that we have available. […] One of the medications I like to talk about is given in the form of an injection under the skin by patients themselves, in the privacy of their own home. […] The next drug that I’m excited about is an oral steroid that’s already been packaged into a slurry formulation, and because it’s a slurry, when the patient swallows it, it coats the lining of the esophagus. […] I’m particularly excited about a drug that’s under investigation. It’s a pill therapy. Patients can just swallow a pill once or twice a day to treat again the inflammation that’s responsible for the symptoms and complications that we see in eosinophilic esophagitis.

• #68 Esophagitis Treatment & Management: Approach Considerations, Reflux Esophagitis, Infectious Esophagitis

  https://emedicine.medscape.com/article/174223-treatment

  The treatment of eosinophilic esophagitis continues to evolve. Various interventions, such as complete avoidance of precipitating food allergens (see Diet), esophageal dilatation, corticosteroids, cromolyn sodium, and leukotriene inhibitors, have been employed. […] In a review of the clinical, endoscopic, and histologic features of eosinophilic esophagitis in adults and children, Dellon and Liacouras noted that this condition can be treated with topical corticosteroids or dietary strategies. […] Endoscopic dilation is an important tool for the treatment of fibrostenotic complications. Unresolved issues include phenotypes, optimal treatment endpoints, the role of maintenance therapy, and treatment of refractory disease. Ideally, eosinophilic esophagitis is managed by a multidisciplinary team comprised of gastroenterologists, allergists, pathologists, and dietitians.

• #69 Management of Eosinophilic Esophagitis

  https://www.aap.org/en/patient-care/eosinophilic-esophagitis/management-of-eosinophilic-esophagitis/?srsltid=AfmBOoofZZibe5EIwYfWmEnMShBK_lYiabGa9DsY-xprfBFq1Mq7Mor6

  EoE is a chronic disease that requires long-term treatment. The goals of treatment are to: […] Treating children with EoE involves diet therapy and/or medical therapy. […] A multi-center, retrospective study drawing from a European database of patients with EoE (adults and children) demonstrated that clinical and histologic remission or response occurred in 82% of patients taking topical steroids, 69% of patients taking proton pump inhibitors, and 42% of patients on empirical elimination diets. […] The choice of treatment depends on the clinical picture, as well as family circumstance and preferences. […] Recent guidelines promote shared decision making and individualized approaches towards management. […] For many children, EoE is a non-IgE-mediated allergic disease, thus removal of relevant food allergens can cause remission of the disease.

• #70 What is EoE? – Children’s Hospital of Orange County

  https://choc.org/programs-services/eosinophilic-esophagitis/eoe/

  How is EoE treated? For children with EoE, the primary goal of treatment is to insure normal growth and development. Steroids and/or dietary modifications are the most common therapies. Treatment regimens are often difficult to maintain and must be individualized according to each family’s concerns and lifestyles. […] What medications help EoE? Some patients with EoE take “swallowed steroids” to destroy the eosinophils, fight inflammation and allow healing to take place. The products that are used for EoE treatment were originally studied in asthmatics. They are approved for use in children. In fact, some of the steroids are approved for children as young as 12 months. […] New therapies called “biologics” have been studied in patients with EoE. It is not known how helpful these man-made antibodies will be in the future.

• #71 Recent advances in the treatment of eosinophilic esophagitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10530275/

  Eosinophilic esophagitis (EoE) is an increasingly common inflammatory allergic disease of the esophagus characterized by esophageal eosinophilia and symptoms of esophageal dysfunction. The therapeutic landscape has rapidly evolved for this emerging type 2 inflammatory disorder. […] After the diagnosis of EoE is established or the status of active EoE is confirmed, treatment is necessary to alleviate symptoms. Moreover, as touched on above, treatment of ongoing, active inflammation is necessary to prevent fibrotic complications including strictures and narrowing. Goals of treatment in EoE include inducing histologic remission (defined as less than 15 eosinophils per hpf) and relieving symptoms of esophageal dysfunction. Consequently, these two goals are often co-primary outcomes in the evaluation of new therapies.

• #72 New drug approvals are reshaping the landscape of Eosinophilic Esophagitis (EoE) treatment | Department of Medicine

  https://www.med.unc.edu/medicine/news/new-drug-approvals-are-reshaping-the-landscape-of-eosinophilic-esophagitis-eoe-treatment/

  As the spotlight remains on EoE treatment, the focus now shifts to understanding dupilumabs optimal utilization, considering factors such as disease progression, response variations, and dosing frequency long-term. […] The ultimate goal is to tailor treatment strategies based on the specific pathogenic mechanisms driving each patients condition.

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