How Eosinophilic Esophagitis Is Treated

Eosinophilic esophagitis is a chronic immune disease that is characterized by a buildup of eosinophils in the lining of the esophagus. Eosinophils are white blood cells that are not normally found in the esophagus and lead to inflammation and damage in the esophagus, the muscular tube that moves foods and drinks from the mouth to the stomach.  

Treatment for eosinophilic esophagitis usually involves dietary changes and prescription medications. This article will describe the different types of treatment options for eosinophilic esophagitis, as well as any side effects you need to be aware of. 

Home Remedies and Lifestyle

One of the most powerful lifestyle changes you can make to manage eosinophilic esophagitis is to your diet. Because this chronic immune disease has been linked to food allergies, eliminating certain foods from your regular diet may reduce inflammation in the esophagus and improve your symptoms. 

Elimination Diet

In an elimination diet, certain foods are completely removed from the diet for a period of time. This approach allows you to notice if taking away a certain food or food group improves your symptoms, such as difficulty swallowing or chest pain. If it does, you may consider permanently eliminating that food from your diet. Diets used to manage eosinophilic esophagitis include:

• Food test–directed elimination diet: If your allergy testing reveals any food sensitivities, those foods are eliminated for a period of time. While this type of diet has not been proven effective in research studies, it may be helpful for some individuals. 
• Empiric elimination diet: An empiric elimination diet eliminates all major food allergens from the diet. These foods usually include dairy, egg, wheat, soy, peanuts, tree nuts, fish, and shellfish. These types of diets have been proven effective at treating eosinophilic esophagitis. To reintroduce the foods back into your diet, your doctor will likely recommend adding one food back at a time and then having an endoscopy performed to look for any signs of eosinophilic esophagitis. This type of diet can be challenging to stick to, so meeting with a dietitian for tips and meal ideas may be helpful. 
• Elemental diet: An elemental diet is the strictest type of elimination diet and involves removing all possible allergens from the diet. Individuals usually receive their nutrition from a liquid amino acid formula. Children may require a feeding tube to ensure they receive enough of the formula to get adequate nutrition. This type of diet is usually used in children who have several food allergies and have not responded to other treatments. 

Prescriptions

Physicians have been successfully using certain medications to lower the number of eosinophils in the esophagus and improve symptoms. Medications commonly used to treat eosinophilic esophagitis include:

• Proton pump inhibitors (PPIs): PPIs reduce the amount of acid in the stomach and are usually used to treat acid reflux disease. PPIs are considered the first-line treatment for eosinophilic esophagitis because they may help to reduce inflammation in the esophagus. While not all individuals respond to PPIs, many have experienced a reduction in the number of eosinophils in the esophagus after starting this medication. This can be measured by performing an upper endoscopy after starting PPI therapy. 
• Corticosteroids: Corticosteroids reduce inflammation in the body. When swallowed in small doses, corticosteroids can treat inflammation in the inner lining of the esophagus. 
• Dupixent (dupilumab): Dupixent is currently the only medical therapy approved by the Food and Drug Administration (FDA) to treat eosinophilic esophagitis. It's an injectable treatment for people 12 and older that works by blocking the release of certain proteins in your body that can cause inflammation. It is also prescribed for several other conditions, including atopic dermatitis and asthma.

Surgeries and Specialist-Driven Procedures

A surgical procedure called esophageal dilation may be needed if dietary changes and prescription medications have not been effective at relieving your symptoms. Over time, people with eosinophilic esophagitis experience a narrowing of their esophagus due to inflammation and scarring. This narrowing makes swallowing food even more difficult and more likely that food will become impacted, or stuck. 

During esophageal dilation, the physician inserts a tube or balloon into the narrowest part of the esophagus and stretches the tissue to make the esophagus wider. This allows for easier swallowing and eating. 

Complementary and Alternative Medicine (CAM)

Research shows that individuals with eosinophilic esophagitis are at an increased risk of experiencing anxiety and depression. Meeting with a psychologist or a therapist to discuss worries and learn coping skills may be helpful as you undergo treatment for this disease. 

Summary 

Eosinophilic esophagitis is a chronic immune disease that causes inflammation and scarring in the esophagus. This damage leads to several symptoms including difficulty swallowing and heartburn. Treatment usually involves an elimination diet and prescription medications. If other treatments have been unsuccessful, esophageal dilation may be recommended. 

A Word From Verywell

Eosinophilic esophagitis is a chronic condition, and there is no known cure. Fortunately, there are ways to manage it with dietary changes and prescription medication. Finding the right treatment regimen often involves trial and error, and the process can feel long and overwhelming. Know that you are not alone, and ask your physician about local support groups or online communities to connect with others who are experiencing the same struggles and frustrations.