Refractory Eosinophilic Esophagitis: What to do When the Patient has not Responded to Proton Pump Inhibitors, Steroids and Diet

Alexandra L. Strauss; Gary W. Falk


Curr Opin Gastroenterol. 2022;38(4):395-401. 

In This Article

How do we Currently Treat Eosinophilic Esophagitis?

Treatments for EoE at present include medications, diet and dilation with the goal of clinical and histologic remission. Although none are FDA-approved, current first-line medications are proton pump inhibitors (PPIs) and topical corticosteroids.[5,6] As there are no oesophageal-specific steroid formulations available in the United States, budesonide or fluticasone formulated for asthma is swallowed instead of inhaled by patients using off-label instructions. EoE can be managed with diet, and the most common approach is the six-food elimination diet (SFED) wherein patients remove the six most common food groups associated with EoE: milk, wheat, eggs, soy, peanuts/tree nuts and fish/shellfish.[7] Current practice is informed by the 2020 AGA and Joint Task Force (JTF) guideline, the 2018 AGREE consensus, the 2017 European guidelines and the 2013 ACG guidelines.[1,4–6] There is currently no first-line therapy per se, and treatment decisions should utilize a shared decision-making model based on efficacy, cost, ease of administration and patient preferences. Of note, the only treatment approach to receive a strong recommendation by the AGA/JTF review was topical corticosteroids.[6] Endoscopic dilation can remedy symptoms that originate from fibrostenotic disease, but will not treat the underlying inflammation.[8–10]