Eosinophilic esophagitis: review of nonsurgical treatment modalities

Eosinophilic esophagitis (EoE) is a clinicopathological condition characterized by the combination of upper gastrointestinal symptoms such as dysphagia and even food impaction in association with histological findings of >15 eosinophils/high-powered field found in endoscopic biopsy specimens. EoE is considered an atopic disease with food and aeroallergen sensitivity. Current treatment options include elemental and elimination diets and topical corticosteroids. This study was designed to provide a review of the literature on the nonsurgical treatment modalities for EoE to understand the therapeutic challenges. A Medline and PubMed search was conducted using the key words eosinophilic esophagitis and treatment. EoE guidelines, randomized controlled trials, case studies, and evidence-based treatment articles in the English literature were selected. EoE patients can have symptomatic and pathological resolutions with dietary modifications and topical swallowed corticosteroids with continued therapy. However, these effects are not long-lasting and adverse reactions, both local and systemic, are possible. Newer targeted therapies using monoclonal antibodies against interleukin-5 (IL-5) appear to be well tolerated but various studies have not consistently shown symptomatic or histological improvement. Current therapies for EoE including specific diets and topical corticosteroids have shown only short-term symptomatic relief. Biological therapies such as anti-IL-5 agents are still under investigation. Long-term effects of treatments are not known and studies regarding safety of these therapies and specific dosing regimens are needed. Therapies targeting the molecules involved in the pathogenesis of EoE may be future options. Treatment should be individualized with careful consideration of patient's age, allergen sensitivity, lifestyle, and compliance.