How is eosinophilic esophagitis treated?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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Answer

The treatment of eosinophilic esophagitis continues to evolve. Various interventions, such as complete avoidance of precipitating food allergens (see Diet), esophageal dilatation, corticosteroids, cromolyn sodium, and leukotriene inhibitors, have been employed. Until the natural history of this disease is understood more fully and appropriate trials are performed, treatment of this condition will continue to be empiric.

In a 2014 review of the clinical, endoscopic, and histologic features of eosinophilic esophagitis in adults and children, Dellon and Liacouras noted that this condition can be treated with topical corticosteroids or dietary strategies. [55] Endoscopic dilation is an important tool for the treatment of fibrostenotic complications. Unresolved issues include phenotypes, optimal treatment end points, the role of maintenance therapy, and treatment of refractory disease. Ideally, eosinophilic esophagitis is managed by a multidisciplinary team comprising gastroenterologists, allergists, pathologists, and dieticians.

A study by Straumann et al suggested that a 15-day course of treatment with budesonide is well tolerated with no serious side effects and is highly effective for remission in adolescent and adult patients with eosinophilic esophagitis. [56]

In a study by Rothenberg et al, QAX576, a monoclonal antibody to interleukin (IL)-13, was found to be efficacious in the treatment of patients with eosinophilic esophagitis refractory to proton-pump inhibitors (PPIs). [57] Intravenous QAX576 or placebo was given at weeks 0, 4, and 8, and patients were followed for 6 months. Efficacy was to be declared if the lower 90% confidence limit for the proportion of responders (those with a greater than 75% decrease in peak eosinophil counts at week 12) on QAX576 was 35% or greater.

Twenty-three patients completed this study up to week 12; 18 continued to the end of the study. [57] For the proximal and distal esophageal biopsies combined, the responder rate was 40.0% for QAX576, compared with 12.5% for placebo. QAX576 was well tolerated. Although the primary end point was not met, the mean esophageal eosinophil count decreased by 60% with QAX576 versus a 23% increase with placebo. The decrease was sustained for up to 6 months.


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