Eosinophilic esophagitis causes inflammation in the esophagus. Treatment options include elimination diets and medications such as Dupilumab, proton pump inhibitors, and corticosteroids.

The esophagus is the tube that carries food from the mouth to the stomach. When swelling occurs in the esophagus, it can make swallowing difficult and affect typical eating. People with eosinophilic esophagitis produce increased eosinophils, a type of white blood cell. This causes inflammation of the esophagus.

Eosinophilic esophagitis treatment aims to decrease symptoms, prevent damage to the esophagus, and improve quality of life. The treatment recommended may depend on the severity of symptoms and whether the person experiences certain symptoms, such as getting food stuck in their esophagus. In some cases, people need a combination of treatments.

The article below covers the treatment for eosinophilic esophagitis and its causes and risks.

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In many people, an abnormal immune reaction to certain foods is the main cause of eosinophilic esophagitis. This is why a healthcare professional may recommend an elimination diet.

As the name suggests, an elimination diet involves removing possible food allergens from a person’s diet. The diets work by identifying the foods that trigger symptoms in an individual and also allowing time for the inflammation in the esophagus to heal.

The two main types of elimination diets include:

Empiric elimination diet

Also known as the six food elimination diet, this diet starts by removing certain foods an individual eats. Doctors often start with the likely triggers. Certain foods commonly cause an allergic reaction, such as:

  • eggs
  • soy
  • animal milk
  • wheat
  • fish and shellfish
  • nuts

An individual stops eating the foods listed above for several weeks. After a few weeks, they add foods back one by one to determine what food triggered the allergic reaction.

Elemental diet

This type of elimination diet involves removing all possible allergens from a person’s diet. The individual gets most or all of their nutrition from a formula containing amino acids. Doctors sometimes allow a few simple foods in addition to the formula.

The formula replacement may continue for 6 weeks to allow the esophagus to heal. Foods less likely to cause an allergic response are then gradually reintroduced.

Dupilumab is the generic name for the brand-name medication Dupixent. Dupilumab received Food and Drug Administration (FDA) approval to treat eosinophilic esophagitis in 2022. Doctors can also use it to treat eczema and asthma.

When used to treat eosinophilic esophagitis, the FDA approval is for people 12 years and over who weigh at least 40 kilograms, around 88 pounds.

Dupilumab is an injectable medication administered weekly. Doctors classify the medication as a biologic drug. It works by reducing inflammation and improving a person’s ability to swallow.

Proton pump inhibitors can help with eosinophilic esophagitis by decreasing the acid in the stomach. Doctors often prescribe this medication to treat acid-related disorders, such as gastroesophageal reflux disease (GERD).

The FDA has not specifically approved proton pump inhibitors as an eosinophilic esophagitis treatment. However, some doctors may prescribe a proton pump inhibitor in combination with other medications and dietary changes.

Doctors may also prescribe topical corticosteroids as an eosinophilic esophagitis treatment. Corticosteroids work by reducing inflammation and suppressing eosinophils in the esophagus. Individuals receive corticosteroids by swallowing formulations from an asthma inhaler, such as inhaled fluticasone.

Doctors usually do not administer systemic steroids, such as prednisone, as a first-line treatment due to the high rate of side effects. Possible side effects of systemic steroids include sleep problems, restlessness, and weight gain. However, in some cases, using systemic corticosteroids for short periods to treat sudden severe symptoms may help.

Doctors believe a combination of environmental factors and genetics may lead to eosinophilic esophagitis. Researchers believe that an atypical response to certain food allergens drives the condition.

Someone with eosinophilic esophagitis may have a hypersensitive response to certain foods. The immune response causes an increase in eosinophils and subsequent inflammation.

There is a link between eosinophilic esophagitis and other allergic conditions. Risk factors include:

  • having environmental allergies, such as asthma or eczema
  • a family history of eosinophilic esophagitis
  • food allergies
  • biological sex, with males having three times the incidence as females

Eosinophilic esophagitis usually occurs due to an allergic reaction from a food trigger. This irregular response causes inflammation and swelling in the esophagus.

The inflammation can lead to difficulty swallowing. It can also cause food to become stuck in the esophagus. Children may be at risk of malnutrition and failure to thrive due to difficulty swallowing.

Treatment aims to stop inflammation, reduce symptoms, and improve swallowing. Treatment options may include elimination diets to determine the food trigger. Doctors may also prescribe medications, such as corticosteroids, proton pump inhibitors, or Dupilumab, to help reduce inflammation.