Eosinophilic Esophagitis: An Evidence-Based Approach to Therapy

Area of Science:

• Gastroenterology
• Immunology
• Allergy

Background:

• Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease.
• Several therapeutic options exist, including dietary modifications, proton pump inhibitors (PPIs), topical corticosteroids, and endoscopic dilation.

Purpose of the Study:

• To provide an evidence-based overview of treatment efficacy for eosinophilic esophagitis.
• To present a practical management algorithm for EoE.

Main Methods:

• Review of randomized controlled trials and meta-analyses.
• Evaluation of therapeutic options: dietary modifications, PPIs, topical corticosteroids, and endoscopic dilation.

Main Results:

• PPIs achieve 50.5% histological and 60.8% symptom remission.
• Topical corticosteroids (budesonide, fluticasone) are superior to placebo.
• Viscous budesonide appears to be the best pharmacological therapy.
• Exclusive amino acid-based diets yield 90.8% remission but have drawbacks.
• Empirical 6-food elimination diets show a 72% remission rate.

Conclusions:

• PPIs and topical corticosteroids are effective first-line treatments for EoE.
• Dietary modifications, particularly empirical 6-food elimination diets, are viable options.
• Viscous budesonide represents optimal pharmacological therapy for EoE.