In recent years,
several randomized
controlled trials
and meta-analyses
have evaluated the
efficacy of the
various therapeutic
options available
for treating
patients with
eosinophilic
esophagitis,
including dietary
modifications,
proton pump
inhibitors, topical
corticosteroids, and
endoscopic
esophageal dilation.
Proton pump
inhibitors are
currently considered
the first-line
treatment for
eosinophilic
esophagitis,
achieving
histological
remission and
improvement of
symptoms in 50.5%
and 60.8% of
patients,
respectively.
The efficacy of
topical
corticosteroids in
eosinophilic
esophagitis has been
assessed in several
trials.
Meta-analyses
summarizing results
indicate that
budesonide and
fluticasone
propionate are
significantly
superior to placebo,
both in decreasing
eosinophil densities
in the esophageal
mucosa and in
relieving symptoms.
However, owing to
differences in drug
delivery, viscous
budesonide seems to
be the best
pharmacological
therapy for
eosinophilic
esophagitis.
Results for dietary
modifications have
been mixed depending
on the type of diet
prescribed. Thus,
while exclusive
amino acidbased
elemental diets are
the most effective
in inducing
histological
remission of
eosinophilic
esophagitis (90.8%),
their severe
drawbacks limit
their implementation
in clinical
practice. Allergy
testingbased food
elimination provides
a suboptimal
remission rate of
45.5%, although this
is lower in adults
than in children
(32.2% vs 47.9%,
respectively). In
addition, the
various available
studies are highly
heterogeneous.
Empirical 6-food
elimination diets
were shown to be the
best diet-based
therapy, with a
homogeneous
remission rate of
72%. Simpler, more
convenient empirical
schemes have also
been evaluated.
The aim of this
review is to provide
an evidence-based
overview on the
efficacy of the
options available
for treatment of
eosinophilic
esophagitis along
with a practical
management
algorithm.
Key words:
Eosinophilic
esophagitis. Diet
therapy. Drug
therapy. Dilation.
Budesonide. Disease
management. |