Consensus Formed on Eosinophilic Esophagitis

Although gastric acid is not thought to be the primary mediator of EE, acid suppression may be considered as cotherapy in patients with established disease who have symptoms secondary to GERD.

For patients who present with symptomatic esophageal narrowing secondary to fixed strictures causing food impaction, esophageal dilatation may be a useful treatment option, the authors wrote. To minimize the risk of mucosal tearing and perforation, however, “a diagnostic endoscopy with biopsy followed by medical or dietary therapy for EE should be attempted prior to performing esophageal dilatation,” they stressed. And the esophagus should be inspected, either radiographically or by gentle endoscopic examination, after dilation to assess for laceration injury before performing larger caliber dilation.

Biologic agents that specifically target eosinophil activity may present a unique treatment opportunity for some patients with EE; however, they cannot yet be recommended for routine use given the lack of clinical trial data to date, according to the authors.

“The motivating factor for treating all patients should be symptom relief and prevention of complications of esophageal strictures and long-segment narrowing,” said Dr. Furuta.