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Eosinophilic esophagitis: Review of nonsurgical treatment modalities

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Abstract:

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.

Keywords: Dysphagia; elemental diet; elimination diet; eosinophilic esophagitis; food allergy; food impaction; gastroesophageal reflux; interleukin-5; topical corticosteroids; treatment

Document Type: Research Article

DOI: https://doi.org/10.2500/aap.2013.34.3690

Affiliations: Department of Medicine, Section of Allergy and Immunology, Penn State University College of Medicine, Hershey, Pennsylvania, USA

Publication date: 2013-09-01

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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