In recent years, several randomized controlled trials and meta-analyses have evaluated the efficacy of the various therapeutic options available for treating patients with
eosinophilic esophagitis, including
dietary modifications,
proton pump inhibitors, topical
corticosteroids, and endoscopic esophageal dilation.
Proton pump inhibitors are currently considered the first-line treatment for
eosinophilic esophagitis, achieving histological remission and improvement of symptoms in 50.5% and 60.8% of patients, respectively. The efficacy of topical
corticosteroids in
eosinophilic esophagitis has been assessed in several trials. Meta-analyses summarizing results indicate that
budesonide and
fluticasone propionate are significantly superior to placebo, both in decreasing eosinophil densities in the esophageal mucosa and in relieving symptoms. However, owing to differences in
drug delivery, viscous
budesonide seems to be the best pharmacological
therapy for
eosinophilic esophagitis. Results for
dietary modifications have been mixed depending on the type of diet prescribed. Thus, while exclusive
amino acid-based elemental diets are the most effective in inducing histological remission of
eosinophilic esophagitis (90.8%), their severe drawbacks limit their implementation in clinical practice.
Allergy testing-based food elimination provides a suboptimal remission rate of 45.5%, although this is lower in adults than in children (32.2% vs 47.9%, respectively). In addition, the various available studies are highly heterogeneous. Empirical 6-food elimination diets were shown to be the best diet-based
therapy, with a homogeneous remission rate of 72%. Simpler, more convenient empirical schemes have also been evaluated. The aim of this review is to provide an evidence-based overview on the efficacy of the options available for treatment of
eosinophilic esophagitis along with a practical management algorithm.