What are the standard management strategies for eosinophilic esophagitis, including both pharmacologic and nonpharmacologic options?
My personal preference is to always try nonpharmacologic options to treat patients first and then move on to medication if those efforts are unsuccessful. EoE is really driven by allergic reactions to foods. If you are able to isolate the food(s) that cause the reaction and can eliminate those foods from the diet, you can successfully treat the EoE. The most common allergens are milk, soy, eggs, nuts, wheat, and shellfish or fish, although any food can be involved. However, finding out which food is causing the reaction is not always easy. Allergy testing is imperfect. In other cases, a patient may be allergic to so many different foods that he or she would need to follow an unrealistically restrictive diet that may not provide proper nutrition or may severely affect quality of life. In these cases, dietary modifications may not be a viable option. For these patients, physicians may want to consider using special formulas or steroid medicines, such as fluticasone (Flovent) and budesonide (Pulmicort). These medications are also used to treat asthma, but patients with EoE swallow the drugs instead of inhaling them. Unlike another common steroid, prednisone, these drugs act on the surface of the esophagus, but don’t enter into the bloodstream to a significant degree, which reduces the likelihood of side effects. However, while side effects are typically reduced, some patients do still experience problems.

Are there any novel treatment approaches that are being used for the condition, and can you discuss the pros and cons of those approaches?
Research is underway to find additional treatments for EoE, but there are currently no FDA-approved treatments for EoE. Some drug companies are currently looking to tailor steroid medications to EoE patients and get them approved by the FDA for use in this population. Currently, the steroids used to treat EoE patients are prescribed off-label.

Resources
The Children’s Hospital of Pennsylvania. Eosinophilic Esophagitis. Available at http://www.chop.edu/service/allergy/allergy-and-asthma-information/eosinophilic-esophagitis.html. Accessed on September 21, 2012. 
 


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