Eosinophilic esophagitis treatment
No FDA-approved treatments for #EoE
Treatment guidelines
40-50% of patients with #EoE respond to PPIs
PPIs can treat EoE in various non-acid suppressing mechanisms
PPIs should be used in #EoE
Fluticasone inhaler or budesonide swallow: the only STRONG recommendation in the guidelines for #EoE
No difference in efficacy between budesonide and fluticasone
About 61% histologic response
Tips for using topical steroids in #EoE
(No need to wash out- oral candidiasis very rare here)
Keep your 👁 out for esophageal-specific steroids!
#Diet in #EoE
1. Most effective (>90%): elemental diet ($, hard to comply)
2.6⃣food elimination diet (72%): milk, egg, wheat, soy, nuts, and seafood
3. Target allergic therapy (46%)– not effective as IgE skin tests do not predict esophageal responses well
SFED
The more restrictive the diet, the better efficacy, but the lower likelihood of adherence
1 food elimination similar to 4 food!
Perhaps start with dairy +/- wheat, and then go from there!
Focus on what CAN be eaten. Partner with patient. Partner with RD. And allergist!
SFED protocol. Lots of work...
Eliminate 6-8 weeks ▶️ endoscopy
If response, add food 6-8 weeks. If active disease on endoscopy, that food is trigger.
#EoE is a chronic condition, and needs maintenance therapy even when in remission.
Disease typically flares within 3 months
Untreated, #EoE transitions from inflammatory to fibrotic
If fibrosis, need to consider dilation
Dilation for #EoE
Note: dilation does NOT impact inflammation, so also need anti-inflammatory therapy
#EoE management algorithm
💎s on #EoE
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