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Mnemonic to remember Features of Esophageal Esophagitis

Eosinophilic esophagitis (EoE) can be a frustrating foe for both patients and physicians. The chronic inflammatory condition, marked by eosinophil infiltration in the esophagus, presents with a range of symptoms that can significantly impact quality of life. Fortunately, there’s an armamentarium of treatment options available, but choosing the right course requires careful consideration.

Dietary Intervention: A Potent Tool

Dietary management is a cornerstone of EoE treatment. The approach often starts with an empirical elimination diet, targeting common food triggers like dairy, wheat, egg, and soy. This can be highly effective, with studies suggesting remission in up to 50% of patients. For those with complex presentations, an elemental diet, devoid of all potential allergens, may be used for initial inflammation control.

Pharmacologic Options: Tailoring Therapy

• Proton Pump Inhibitors (PPIs): Despite not directly addressing the underlying cause, PPIs can provide symptomatic relief in some patients, possibly due to their anti-inflammatory properties. The response rate is around 30%, making them a consideration, particularly for those with co-existing reflux symptoms.
• Topical Corticosteroids: These medications, delivered via orodispersible tablets or swallowed from inhalers, directly target esophageal inflammation. They are more effective than PPIs, with remission rates approaching two-thirds in some studies.
• Dupilumab: The FDA-approved biologic agent dupilumab offers a promising new avenue. It targets the IL-4 and IL-13 pathways, key players in allergic inflammation. Studies indicate good efficacy and safety profiles, making it a valuable option, particularly for patients with steroid-refractory disease.

Endoscopic Dilation: Addressing Strictures

Esophageal strictures, a potential complication of EoE, can be managed with endoscopic balloon dilation. This minimally invasive procedure helps restore esophageal patency and improve swallowing difficulties.

Optimizing Treatment: A Shared Journey

The ideal EoE treatment plan is a shared decision between physician and patient. Factors like disease severity, patient preference, and potential side effects all influence the choice of therapy. A stepwise approach, starting with dietary interventions and progressing to pharmacologic options as needed, is often employed.