Review on the Treatment of Eosinophilic Esophagitis in Adults

Introduction

Eosinophilic esophagitis (EoE) was first described by Landres et al

and is characterized by eosinophils in the squamous epithelium or deeper layers of the esophagus. The hallmark of this condition is intermittent dysphagia although symptoms such as odynophagia, food impaction, heartburn, and chest pain often coincide.

Abstract

Eosinophilic esophagitis (EoE) is a clinicopathologic disease characterized by abnormal eosinophilic infiltration in the esophagus with associated symptoms including dysphagia, strictures, and food impaction. While esophageal eosinophilic infiltration was historically attributed to gastroesophageal reflux disease (GERD), recognition of an association between EoE and allergies has emerged. As such, therapeutic strategies have focused on allergen avoidance and treatment of eosinophil-derived inflammation. The mainstays of therapy include dietary modification, systemic steroids, topical steroids, proton pump inhibitors, leukotriene receptor antagonist, immunomodulating agents, and endoscopic dilation. However, few randomized controlled studies assessing these modalities are available. Further treatment endpoints, long-term prognosis, and the role of maintenance therapy in EoE remains unclear. This review will focus on the efficacy of current and emerging treatment strategies for adult patients with EoE.

Keywords

eosinophilic esophagitis, fluticasone, proton pump inhibitor, topical corticosteroids, systemic corticosteroids, elemental diet, esophageal dilation