ausEE Inc.

There is no cure for an EGID and EoE, but the goal of treatment is to eliminate the eosinophils in the affected area, thereby alleviating symptoms and reducing inflammation to minimal safe levels. Treating specialists should discuss the options with patients/families and tailor treatment to the individual. EGIDs are chronic diseases that require ongoing management and monitoring with endoscopies and repeat biopsies. As symptoms can fluctuate, they alone are not a reliable indication of disease control. EoE not treated adequately often leads to worsening of the condition with symptoms such as food impactions becoming more frequent. New monitoring methods and treatment options (including biologic therapies) are on the horizon.

Current treatment options for EoE include:

Elimination diet - It is important to speak with an Allergist and/or Gastroenterologist, and have a Dietitian experienced in food allergy before undertaking an elimination diet. Some individuals may be able to identify specific food(s) that trigger symptoms, but most cannot. More than one food may be involved. Some doctors suggest removal of up to 6 common food allergens (milk, egg, soy, wheat, peanut/tree nut, shellfish/fish). A common approach is the ‘step-up’ elimination diet with at first, only one or two food groups (usually milk/dairy and wheat as the most common triggers) being eliminated and then more if required. Foods outside of the common allergens can also be EoE triggers. There is currently no test (skin prick test, blood test etc.) that can reliably indicate the specific food trigger(s) in EoE. With any elimination diet it is important to ensure diet is balanced, growth is maintained and a plan is in place to re-assess.

Elemental diet - This consists of a special medical food called an elemental/amino acid-based formula. It provides all the nutrition a person needs if enough is taken. Some individuals need a feeding tube to ensure they are getting enough of the formula or to give the oesophagus a rest. The person is placed on the formula alone for a number of weeks and will have a repeat endoscopy. If the condition has improved, then foods are slowly introduced back into the diet and a repeat endoscopy is often performed to ensure ongoing control with food reintroduction.

Medication - The most common medications used in EoE are swallowed corticosteroids, often a fluticasone puffer (which is swallowed), budesonide ampoules (made into a slurry) or budesonide orally disintegrating tablets (for adults). These coat the oesophagus and assist in getting rid of eosinophils. Acid reflux medications/proton pump inhibitors (PPIs) may also be used, as they can decrease eosinophils in addition to their anti-acid effect. The doctor will determine which, if any, medications are appropriate for each individual. Medications can be used alone and/or along with dietary management.

Oesophageal dilation - This can be used in people with severe narrowing or strictures of the oesophagus to provide instant relief, and in those with long-standing symptoms who have tried diet or medications and have not improved. Whilst dilation in EoE is safe, this treatment involves an endoscopic procedure and is best used in carefully selected cases.