Patients with eosinophilic gastrointestinal disorders such as eosinophilic esophagitis (EoE) have two primary treatment options, broadly represented as either dietary or medicine-based therapies. For the treatment of EoE, the use of either dietary or medicine-based therapies can lead to resolution of the pathology seen within the esophagus as well as control of the symptoms associated with EoE.  Chronic treatment, however, is required to maintain disease remission.

Dietary Therapies

For the dietary therapies, treatment options include allergy test-guided elimination diet, empiric elimination diet, and elemental diets. Allergy test guided elimination diets rely upon findings noted on skin and patch testing with patients eliminating any food noted to be positive on these tests.  In contrast, empiric elimination diets uses historical knowledge gathered regarding IgE-mediated food allergy to select which foods to avoid. These 6-8 foods have previously been established as foods that are most commonly associated with sudden allergic reactions such as hives, loss of consciousness, or severe respiratory difficulties in patients with no known history of eosinophilic gastrointestinal disorders. Finally, for elemental diets, patients receive a formula either by mouth or via a tube as their only source of nutrition. In this case, proteins are entirely eliminated by the use of an amino acid-based elemental formula that only contains the building blocks for proteins (amino acids). Unlike the fully “built” proteins, these amino acid building blocks are not recognized by the body as allergens and therefore help relieve symptoms and disease.

For all of the dietary therapies, the primary benefit is derived from the avoidance of foods that trigger inappropriate reactions in the body that lead to the eosinophilic pathology and symptoms.  After disease remission is achieved with dietary therapy, foods are slowly added back into the diet under the guidance of a doctor and dietician, and endoscopies are generally used to monitor disease activity.

Medicine-based Therapy

The primary medicine-based therapy used for patients with eosinophilic gastrointestinal disorders such as EoE is usually glucocorticoids (a type of steroid) such as fluticasone propionate or budesonide. These medications were developed for control of asthma symptoms and pathology and have been repurposed for treatment of EoE by changing how the drug is delivered. For EoE, fluticasone propionate is swallowed rather than being inhaled from an inhaler device, while budesonide is mixed with an artificial sweetener prior to being swallowed rather than being inhaled from a nebulizer device. The delivery of steroids to the rest of the body is limited by applying the topical steroid agent locally in the esophagus to reduce inflammation.

For patients with more severe disease, the use of systemic oral steroids that deliver medicine to the entire body is sometimes considered. For patients with disease that exists within the gastrointestinal tract but outside of the esophagus, additional medicines are also used such as specialized preparations of either budesonide or aminosalicylates (5-aminosalicylic acid) designed for delivery to specific parts of the gastrointestinal tract. 

A variety of additional immunological modifiers (such as anti-IL-5 and anti-IL-13) are under active investigation.  It is important to note that no medical therapy has been FDA approved for eosinophilic gastrointestinal disorders, as such the usage of these medicines is “off label” and should be done with careful consideration.

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