Treatment

Eosinophilic oesophagitis (EoE) is a condition that will need lifelong management. This can involve preventative measures, such as changes in a person's diet, or medication, which is often used to treat flares of the condition.

Occasionally, other treatments may be required. If EoE is not treated, sometimes scarring can occur, resulting in narrowing of the gullet. If this happens, further telescope procedures and treatments can be needed (see below under the heading 'Endoscopic treatment').

With careful and proactive management, most people who have EoE can maintain a good quality of life.

Dietary management

If you have EoE, you may be allergic to certain foods. You may be referred to a dietician to discuss how to identify which food this may be. This can involve a very careful diet in which several different types of food are all avoided for 4-6 weeks to see if this improves a person's symptoms. Then, different food groups may be re-introduced one at a time to see which food type causes the problem. This process can be difficult to stick to, and should only be done with input from a qualified dietitian. Some people need supplements to ensure that they are getting all the nutrients they need. It can take months to work through the whole diet and identify the food type that causes symptoms. However, if this is done properly, it can give a long-term way of controlling the condition. Unfortunately, it is not always possible to identify a food type that causes symptoms for every patient.

To help people manage their diet, some people find it very useful to use specially designed apps on their smartphone or other handheld device. This can be discussed with your dietitian or doctor. It is important to note that we are not responsible for third party content which may change over time.

Medications

You may be offered medications to try and treat EoE. One first line medication is an acid-lowering tablet called a proton pump inhibitor. This does not treat the underlying problem behind EoE. However, it may ease the inflammation and improve some of the symptoms. For some patients, this is enough to help manage their symptoms. However, for many patients this medication on its own does not improve their symptoms long term.

The main treatment recommended for EoE is steroid medication. This is usually a dissolvable tablet that you place on your tongue. As you swallow this with saliva, the steroid coats your gullet. This medication is normally taken twice a day for 6 weeks to see if your symptoms improve. Longer courses can be given if needed. Currently this medication needs to be started by a specialist in hospital.

Endoscopic treatment

Over time, irritation or inflammation in the gullet can lead to narrowing of the tube. If a person with EoE develops a narrowing in their gullet (called a stricture), this can make it difficult to get food, or sometimes even fluids, to pass into the stomach. This can be treated with an upper GI endoscopy and stretch with an inflatable balloon (called a dilation). This procedure can be very effective in improving a person's swallowing, but it also has risks of causing problems. These include tearing a hole in the gullet. Although the risk of this is low, it can be very serious if it occurs. Endoscopy and balloon dilation can help treat a narrowing, but will not treat the underlying EoE, so without effective treatment the narrowing can come back. This is one of the reasons why it is important to treat EoE, to try and limit the inflammation and prevent the development of narrowing.

Figure 1. Endoscopic balloon dilation of an oesophageal stricture. Source: UHBW NHS Foundation Trust.

Figure 2. Endoscopic balloon dilation of an oesophageal stricture - annotated picture. Source: UHBW NHS Foundation Trust.