Management of Eosinophilic Esophagitis
- Eosinophilic esophagitis (EoE) was first characterized in the early 1990s and understood to be a food antigen-driven Th2 inflammatory condition.
- A large body of evidence suggests that EoE subjects have aeroallergen sensitization and concurrent atopic diseases including asthma, allergic rhinitis and eczema.
- There is a close interaction between these organ-specific diseases and a potential for common triggering antigens in EoE and other atopic conditions.
Treatment of Eosinophilic Esophagitis (EoE) Clinical Decision Support Tool
1 Secondary causes of esophageal eosinophilia:
- Gastroesophageal reflux disease
- Eosinophilic gastrointestinal disease
- Hypereosinophilic syndrome
- Esophageal Crohn’s disease
- Infections (fungal, viral)
- Connective tissue disorders
- Autoimmune disorders
- Drug hypersensitivity reactions
- Pill esophagitis
- Stasis esophagitis
- Graft versus host disease
- Marfan syndrome type II
- Hyper-IgE syndrome
- PTEN hamartoma tumor syndrome
- Netherton’s syndrome
- Severe atopy metabolic wasting syndrome
Recommendation in favor of empiric elimination diets is based on the published experience with the six food elimination diet ( 2SFED). 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.
Due to the potential limited accuracy of the currently available, allergy-based testing for the identification of specific food triggers for 4EoE, 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.
- AGA/JTF: American Gastroenterology Association/Joint Task Force
- EoE: Eosinophilic Esophagitis
- IL: Interleukin
- IgE: Immunoglobulin E
- SFED: Six Food Elimination Diet
- TNF: Tumor Necrosis Factor
|95044||Patch or application test(s) (specify number of tests)|
|95004||Percutaneous tests (scratch|
|95028||Intracutaneous (intradermal) tests with allergenic extracts|
|95024||Intracutaneous (intradermal) tests with allergenic extracts|
|95079||Ingestion challenge test (sequential and incremental ingestion of test items|
|95076||Ingestion challenge test (sequential and incremental ingestion of test items|
|95027||Intracutaneous (intradermal) tests|
|K20.0||Eosinophilic esophagitis||Type, Contributing factors||RXHCC68|