Eosinophilic esophagitis is considered a chronic relapsing disease, meaning that most people will require ongoing treatment to control their symptoms. Treatment will involve one or more of the following:
Depending on your response to tests for food allergies, your doctor may recommend that you stop eating certain foods, such as dairy or wheat products, to relieve your symptoms and reduce inflammation. A more limited diet is sometimes required. Your doctor may refer you to an allergist for specific recommendations.
Your doctor will likely first prescribe an acid blocker such as a PPI. This treatment is the easiest to use, but most people's symptoms don't improve. If you do not respond to the PPI, your doctor will then likely prescribe a topical steroid, such as fluticasone or budesonide, which is taken orally to treat eosinophilic esophagitis.
This type of steroid is not absorbed into the bloodstream, so you are unlikely to have the typical side effects often associated with steroids. If a topical steroid is not effective or you need more immediate symptom relief, you may be prescribed prednisone.
Steroids may decrease the buildup of eosinophils in the esophagus, reduce the inflammation associated with an allergic reaction, and allow your esophagus to heal. Some people may need to take steroids on an ongoing basis.
If you experience severe narrowing (strictures) of your esophagus, your doctor may recommend dilation to help make swallowing easier. Dilation may be used if steroids are not helpful.
Because people with eosinophilic esophagitis can have bleeding or tearing of their esophagus, doctors have been concerned about the safety of dilation, especially of perforation during the procedure. Studies have found that dilation is safe and may provide symptom relief for some people — though it may initially be painful. However, it does not improve the underlying inflammation.
Depending on your situation, you may have access to experimental treatments as part of Mayo Clinic's research on long-term management of eosinophilic esophagitis.
June 19, 2014
- Bonus PAL, et al. Pathogenesis, clinical manifestations, and diagnosis of eosinophilic esophagitis. http://www.uptodate.com/home. Accessed Jan. 28, 2014.
- Dellon ES, et al. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). The American Journal of Gastroenterology. 2013;108:679.
- Feldman M., et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 9th ed. Philadelphia, Pa.: Saunders Elsevier; 2010. http://www.clinicalkey.com.Accessed Jan. 18, 2014.
- Liacouras CA, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. Journal of Allergy and Clinical Immunology. 2011;128:3.
- Fell JME. Recognition, assessment and management of eosinophilic oesophagitis. Archives of Disease in Childhood. 2013;98:702.
- Picco MF (expert opinion). Mayo Clinic, Rochester, Minn. April 6, 2014.
- Gorospe EC, et al. New diagnostic and therapeutic frontiers in eosinophilic esophagitis. Minerva gastroenterologica e dietologica. 2013;59:59.
- Medical Edge from Mayo Clinic. Hard to Swallow — EOE. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014. http://www.mayoclinic.org/medical-edge/. Accessed March 9, 2014.
- Molina-Infante J, et al. Review article: Proton pump inhibitor therapy for suspected eosinophilic oesophagitis. Alimentary Pharmacology & Therapeutics. 2013;37:1157.
- AskMayoExpert. Eosinophilic esophagitis (EE). Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2014.
- Eosinophilic esophagitis. American Academy of Asthma, Allergy and Immunology. http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis.aspx. Accessed Jan. 28, 2014.
- Alexander JA (expert opinion). Mayo Clinic, Rochester, Minn. March, 2014.
- Hirano I. Dilation in eosinophilic esophagitis: To do or not to do? Gastrointestinal Endoscopy. 2010;71:713.
- Lucendo AJ, et al. Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: A prospective study on the food cause of the disease. Journal of Allergy and Clinical Immunology. 2013;131:797.
- Katzka DA. The skinny on eosinophilic esophagitis. Gastroenterology. 2013;145:1186.
- Hurrell JM, et al. Prevalence of esophageal eosinophilia varies by climate zone in the United States. American Journal of Gastroenterology. 2012;107:698.
- Dellon ES. Diagnosis and management of eosinophilic esophagitis. Clinical Gastroenterology and Hepatology. 2012;10:1066.
- Safe use of complementary health products and practices. National Center for Complementary and Alternative Medicine. http://nccam.nih.gov/health/safety. Accessed Jan. 2, 2014.
- Rakel D. Integrative Medicine. 3rd ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Jan. 2, 2014.
- Fass R. Alternative therapeutic approaches to chronic proton pump inhibitor. Clinical Gastroenterology and Hepatology. 2012;10:338.
- Golden AK. Decision Support System. Mayo Clinic, Rochester, Minn. March 10, 2012.
- U.S. News best hospitals 2013-2014. U.S. News & World Report. http://health.usnews.com/best-hospitals/rankings/gastroenterology-and-gi-surgery. Accessed March 9, 2014.