Eosinophilic Esophagitis (EOE) Treatment Options

There are three main categories of treatment for eosinophilic esophagitis: medication, diet, and procedures to widen the esophagus when needed. These approaches can be used alone or in combination depending on each person’s symptoms and lifestyle.

Medications

They are a common first step.

1. 1. Proton pump inhibitors (PPIs), which are often used to reduce stomach acid, can improve eosinophilic esophagitis in some people, though they do not work for everyone.
   2. Swallowed topical steroids, which coat the esophagus and directly reduce inflammation, are more effective for many patients and can bring significant relief.
   3. A newer option called oral steroid suspension (Eohilia) is designed specifically for eosinophilic esophagitis and has been shown to reduce inflammation in more than half of patients after a few months of treatment.
   4. Biologic therapy, such as Dupilumab, works by targeting the immune system response that drives eosinophilic esophagitis and may be used when other treatments are not enough or when the disease is severe.
   5. Systemic steroids taken as pills or liquid can also quickly control symptoms, but they are not used long-term due to side effects and the high chance of relapse when they are stopped.

Dietary therapy

This is another major treatment option because food triggers are often behind the inflammation in eosinophilic esophagitis. The elemental diet, which replaces all food with special amino acid-based formulas, is the most effective but also the hardest to follow. More practical for many patients are elimination diets, where common triggers like dairy, wheat, eggs, soy, nuts, and seafood are removed. Foods are then added back one at a time to identify the specific cause. Even less restrictive elimination diets that remove only two or four foods can bring significant improvement. In some cases, people try allergy-directed diets based on testing, though this approach is less reliable. Working with a dietitian helps patients avoid nutritional problems and makes dietary therapy easier to follow.

Endoscopic Dilation

When the esophagus becomes very narrow due to scarring or long-term inflammation, endoscopic dilation may be recommended. This procedure gently stretches the esophagus during an endoscopy, making it easier to swallow. Dilation does not treat the underlying inflammation, so it is usually combined with medication or diet changes, but it can provide quick and lasting relief for swallowing difficulties.

Each treatment option has different levels of effectiveness.

• Swallowed steroids and oral steroid suspensions bring relief for many patients and are relatively easy to use.
• Elemental diets have the highest success rates but are difficult to maintain, while elimination diets strike a balance between effectiveness and everyday lifestyle.
• PPIs may help in milder cases, while biologic therapy is showing strong results for people who have not responded to other options.
• Endoscopic dilation is very effective for improving swallowing when the esophagus is narrowed.

At Rockford Gastroenterology we understand that eosinophilic esophagitis affects people differently, so we individualize each person’s treatment plan. Some people may do well with a single therapy, while others may need a combination to control inflammation and prevent complications. The main goals of treatment are to reduce inflammation, ease symptoms, and protect the esophagus from long-term damage.

Eosinophilic esophagitis is a chronic condition, but with proper treatment most people can manage their symptoms successfully and live comfortably. At Rockford Gastroenterology, our specialists work with each patient to create a treatment plan that fits their unique needs and lifestyle, helping them maintain a healthy esophagus and a better quality of life.