Treatment
Treatment of Eosinophilic Esophagitis (EoE)
Clinical Decision Support Tool
Suspected eosinophilic esophagitis
Eosinophilic esophagitis
1
1
Secondary causes of esophageal eosinophilia:
2
Recommendation in favor of empiric elimination diets is based on the published experience with the six
food elimination diet (SFED). Patients who put a higher value on avoiding the challenges of adherence
to diet involving elimination of multiple common food staples and the prolonged process of dietary
reintroduction may reasonably decline this treatment option. Emerging data on less restrictive diets (4 food,
milk elimination, 2-4-6 step up diet) may increase both provider and patient preference for diet therapy.
3
Patients who put a higher value on avoiding the challenges of adherence to an elemental diet and the
prolonged process of dietary reintroduction may reasonably decline this treatment option.
4
Due to the potential limited accuracy of the currently available, allergy-based testing for the identification
of specific food triggers for EoE, patients may prefer alternative medical or dietary therapies to an exclusively
testing-based elimination diet.
5
Esophageal dilation does not address the esophageal inflammation associated with eosinophilic esophagitis.
Maintenance therapy
Medical therapy
• Proton pump inhibition
• Topical corticosteroids
Esophageal dilation
5
Clinically
relevant
esophageal
stricture
Diet therapy
• Empiric elimination
2
• Elemental formula
3
• Allergy testing directed
4
Response
Non response
Non response
Response
• Gastroesophageal reflux disease
• Eosinophilic gastrointestinal disease
• Achalasia
• Hypereosinophilic syndrome
• Esophageal Crohn's disease
• Infections (fungal, viral)
• Connective tissue disorders
• Autoimmune disorders
• Vasculitis
• Drug hypersensitivity reactions
• Pill esophagitis
• Stasis esophagitis
• Gra versus host disease
• Marfan syndrome type II
• Hyper-IgE syndrome
• PTEN hamartoma tumor syndrome
• Netherton's syndrome
• Severe atopy metabolic wasting syndrome
