Treatment Options:

The initial approach is often allergy evaluation in an attempt to identify the allergens in the diet or environment that may be triggering the disease. Treatment strategies include medical therapy, mechanical dilatation of the esophagus, and dietary modification to exclude food allergens. If the offending agent is found, the diet is modified so that these allergens are eliminated. There are cases, especially in children, where multiple food allergies are involved. Some patients require an elemental diet through the use of a specialty formula. Adhering to this diet and drinking the required amount of formula can be difficult.

A minority of EoE patients appear to be non-atopic (i.e., nonallergic), yet still present with this disease. EoE can cause severe pain in many patients. First-line therapy is with swallowed liquid corticosteroids. Proton pump inhibition (PPI) historically had no role in the treatment of EoE, although some recent evidence suggests that a significant proportion of patients with suspected EoE achieve clinicopathological remission on PPI therapy. EoE patients, by definition, have persistent symptoms, even with acid-inhibition therapy.

For this reason, alternative medical therapies are often employed. Treatments that target the inflammation or attempt to halt the allergic response may be used.

Mechanical dilatation may be considered in severe cases of EoE that have progressed to esophageal stricture or severe stenosis. Dilatation is accomplished by passing dilators through the mouth and down the esophagus to gently expand its diameter. Since the esophagus of patients with EoE may be thin and delicate, care is taken not to perforate the esophagus by overzealous dilatation.

Questions to Ask Your Healthcare Provider:

• What treatment option is best for me?
• What are the potential side effects?
• What dietary or lifestyle changes do you recommend?