First-Line Treatment Options for Eosinophilic Esophagitis
Clinical Scenario
This protocol addresses initial management for patients with symptomatic esophageal eosinophilia (EoE) who have not previously received treatment for this condition.
Treatment Goal
The primary objective is achievement of histologic remission, defined as an esophageal eosinophil count below 15 eosinophils per high power field, assessed at approximately 8 weeks after treatment initiation.
<15 eos/hpf at ~8 weeks
Treatment Approach (partial)
First-line management involves a choice among several alternatives to no treatment, spanning both pharmacological and dietary strategies — the full structured protocol details each option and the evidence supporting it.
References
DOI: 10.1053/j.gastro.2020.02.038
- In patients with symptomatic esophageal eosinophilia, the AGA/JTF suggests using proton pump inhibition over no treatment.
- In patients with EoE, the AGA/JTF recommends topical glucocorticosteroids over no treatment.
- Eight double-blind placebo-controlled studies enrolling 437 patients followed for a mean of 8 weeks compared treatment with topical budesonide or topical fluticasone to placebo.
- In patients with EoE, the AGA/JTF suggests using elemental diet over no treatment.
- In patients with EoE the AGA/JTF suggests using an empiric six-food elimination diet over no treatment.
- In patients with EoE, the AGA/JTF suggests allergy testing-based elimination diet over no treatment.
- With the exception of the recommendation on esophageal dilation, the guidelines are based on the failure to achieve histologic remission of <15 eosinophils/high power field (eos/hpf) as the definition of treatment effect.
- Until such metrics are established, a threshold of <15 eos/hpf to define an adequate therapeutic response serves as a response criterion until a better measure is established.
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