EGD Masterclass: EoE, Strictures, and Pre-malignant Gastric Conditions (On-demand) | January 2023-Hirano_Eosinophilic Esophagitis Diet and Medical Therapy

Hirano_Eosinophilic Esophagitis Diet and Medical Therapy

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This document discusses the management of eosinophilic esophagitis (EoE), a condition characterized by inflammation of the esophagus. The document highlights the use of proton pump inhibitors (PPIs) and swallowed topical corticosteroids as initial therapies. PPIs are no longer required for the diagnosis of EoE but are recommended as a first-line treatment option. Swallowed topical corticosteroids have shown benefits in both children and adults with EoE but have potential side effects and require regulatory approval.<br /><br />The document also discusses dietary therapy for EoE, including elemental diets, empiric elimination diets, and allergy testing-based elimination diets. The American Gastroenterological Association (AGA) suggests using elemental diets or empiric elimination diets over no treatment. However, the quality of evidence for allergy testing-based elimination diets is very low.<br /><br />The use of less restrictive diet approaches, involving milk alone or a step-up approach, has shown effectiveness in managing EoE. The document recommends consulting with a dietician and involving an allergist for concomitant IgE mediated food allergy. The commitment to multiple endoscopies during the reintroduction process is emphasized.<br /><br />The document introduces the use of the biologic therapy, dupilumab, for EoE. Dupilumab inhibits signaling of IL-4 and IL-13 and has been approved for the treatment of atopic dermatitis, asthma, and chronic rhinosinusitis with nasal polyps. Dupilumab has shown efficacy in reducing dysphagia, esophageal eosinophilia, and endoscopic disease activity in EoE. The FDA approval for children and adults with EoE is primarily for PPI non-responders and those with concomitant asthma or atopic dermatitis.<br /><br />The document mentions other potential biologic and oral immunomodulators in development for the treatment of EoE and eosinophilic gastrointestinal disorders (EGIDs). However, these therapies are still in various phases of clinical trials.<br /><br />Overall, shared decision-making is emphasized in choosing the initial therapy for individual patients with EoE, taking into account the effectiveness, administration, safety, and cost of the different treatments. EoE management includes a combination of medical therapy, dietary therapy, and maintenance therapy, such as esophageal dilation.

Keywords

eosinophilic esophagitis

inflammation

esophagus

proton pump inhibitors

swallowed topical corticosteroids

elemental diets

empiric elimination diets

allergy testing-based elimination diets

biologic therapy

dupilumab