Eosinophilic esophagitis (EoE), typically a pediatric disease, is becoming more frequently recognized in adults. The optimal treatment of EoE in this population has not yet been established. This paper reviews the literature detailing the treatments for EoE in adults, and provides a treatment strategy. To accomplish this task a comprehensive literature search of Medline was undertaken for studies evaluating the treatment of EoE in adults. High-dose topical corticosteroids and specific elimination diets have been found to improve symptoms, reduce eosinophilic infiltrate in esophageal mucosa, and improve endoscopic markers of inflammation. Dilation therapy does improve symptoms but not underlying inflammation. Other treatments including leukotriene inhibitors and immunomodulatory drugs have been unsuccessful. An effective strategy for treating EoE in adults is using topical corticosteroids and elimination diets for inflammatory disease, and esophageal dilation for fibrotic disease. The conclusion that inflammatory and fibrotic components of EoE respond to different treatment modalities should be evaluated in future clinical trials.
*Department of Medicine
†Division of Gastroenterology, The University of Western Ontario and London Health Sciences Centre, London, ON, Canada
D.S. has no financial interests to declare. N.C. has received speaker fees from Warner-Chilcott, Abbot, and Merck, and consulting fees from Jansen, Abbott, Ferring, and Aptalis.
The authors declare that they have nothing to disclose.
Reprints: Dan Segal, MD, c/o Nilesh Chande, MD, FRCPC, Department of Medicine, Division of Gastroenterology, London Health Sciences Centre, Victoria Hospital, Room E1-423A, 800 Commissioners Road East, London, ON, Canada N6A 5W9 (e-mail: firstname.lastname@example.org).