Treatment
Treatment strategies include dietary modification to exclude food allergens, medical therapy, and mechanical dilatation of the esophagus. The initial approach to the disorder is often allergy evaluation in an attempt to identify the allergens in the diet or environment that may be triggering the disease. If the offending agent is found, the diet is modified so that these allergens are eliminated. There are cases, especially in children, where there are multiple food allergies involved. Some patients require an elemental diet through the use of a specialty formula. Sticking to this diet and drinking the required amount of formula can be difficult. The use of feeding tubes in these situations is often A minority of EE patients appear to be non-atopic (non-allergic), yet still present with this disease. Eosinophilic Esophagitis can cause severe pain in many patients.
First line therapy is with swallowed liquid corticosteroids. Proton Pump inhibition historically had no role in the treatment of eosinophilic esophagitis, although some recent evidence suggests that a significant proportion of patients with suspected EE achieve clinicopathological remission on PPI therapy. EE patients by definition have persistent symptoms even with acid-inhibition therapy. For this reason, alternative medical therapies are often employed. Treatment that targets the inflammation includes swallowed corticosteroids such as fluticasone,a topical viscous budesonide oral suspension. Medications such as leukotriene antagonists like montelukast, and anti-interleukins such as the anti-IL-5 monoclonal antibody mepolizumab and other drugs attempt to halt the allergic response; these include antihistamines such as loratadine show little if any clinical benefit. Patients with severe symptoms despite these interventions may require oral corticosteroids such as methylprednisolone.
Mechanical dilatation may be considered in severe cases of EE that have progressed to esophageal stricture or severe stenosis. Dilatation is accomplished by passing dilators through the mouth and down the esophagus to gently expand its diameter. As the esophagus of patients with EE is rather thin and delicate, care is taken not to perforate the esophagus by overzealous dilatation.
Read more about this topic: Eosinophilic Esophagitis
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