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Eosinophilic Esophagitis in Adults: an Update on Medical Management

  • Ricardo Prieto
  • Joel E. Richter
Esophagus (L Gerson, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Esophagus

Abstract

Management of eosinophilic esophagitis (EoE) centers around the 3 Ds: diet, drug therapy, and dilation. Unfortunately, there is not a consistent relationship between symptom relief and resolution of mucosal eosinophilia. Elemental diets are very successful in children, but poorly tolerated by adults. The 6-food elimination diet is more attractive to adults, especially for those individuals with multiple food allergies. Steroids are the preferred anti-eosinophil drug for EoE. Oral prednisone is infrequently used because of side effects. Topical swallowed preparations (fluticasone, budesonide) are preferred for acute and possibly maintenance therapy. Relapses off steroids are frequent and dysphagia does not predictably improve. Esophageal dilation is key treatment for patients with the fibrostenotic phenotype of EoE. Long-term symptom relief for 1–2 years is common. Post-procedure chest pain is to be expected but perforation is very rare. A suggested algorithm for the treatment of EoE based on endoscopic phenotypes is outlined.

Keywords

Eosinophilic esophagitis Allergy testing Elemental diet 6-food elimination diet Corticosteroids Prednisone Fluticasone Budesonide Proton pump inhibitors Esophageal dilation 

Notes

Conflict of Interest

Ricardo Prieto declares that he has no conflict of interest.

Joel E. Richter declares that he has no conflict of interest.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Division of Digestive Diseases and NutritionUniversity of South Florida Morsani College of MedicineTampaUSA
  2. 2.Division of Digestive Diseases and Nutrition, Joy McCann Culverhouse Center for Esophageal and Swallowing DisordersUniversity of South Florida Morsani College of MedicineTampaUSA

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