Los Angeles Allergist

Los Angeles Allergist

Alan Khadavi, MD, APC
  • Home
  • Meet Dr. Khadavi
  • Conditions We Treat
  • Your First Visit
  • Insurance Accepted
  • Allergy and Asthma Info
    • Asthma Info
    • Allergic Rhinitis
    • Allergic Triggers
  • Blog
  • Media
  • Contact Us

9001 Wilshire Blvd. Suite 204
Beverly Hills, CA 90211
Phone: 310-282-8822

16260 Ventura Blvd., Suite 140
Encino, CA 91436
Phone: 818-528-7776

February 6, 2020 by Alan Khadavi

Eosinophilic Esophagitis (EoE) Treatment

Eosinophilic esophagitis (EoE) is an eosinophilic rich gastrointestinal/allergy disease increasing in pediatrics and adults worldwide.  The diagnosis requires greater than or equal to 15 eosinophils per high-power field on light microscopy after a biopsy.  Symptoms reflect esophageal dysfunction, and typical endoscopic features include linear furrows, white plaques, and concentric rings. Progressive disease leads to tissue remodeling with rigidity and strictures.

Effective treatment can reverse tissue fibrosis in some patients as well as decrease the rate of food impactions.  Esophageal dilation might be required to increase luminal patency. The chronic nature of EoE necessitates long-term therapy to avoid disease recurrence and complications.

After an endoscopy is done and there are greater than 15 eosinophils per high power field, in addition to the typical symptoms and typical endoscopic features, a diagnosis of EoE can generally be made.  At that point a referral to an allergist is warranted. An allergy doctor can help control environmental exposure, help manage concurrent allergic diseases and identify triggers. Next treatment is warranted which can entail:

  1. A proton pump inhibitor (PPI) for 8 weeks.
  2. Dietary therapy for 6-8 weeks. Elemental diets, allergy testing-directed elimination or an empiric elimination diets can all be tried.
  3. A topical corticosteroid for 8-12 weeks.

After that, a reassessment should be done. Most guidelines recommend a repeat endoscopy with another esophageal biopsy. In the practical real world setting this maybe very difficult to do, especially in pediatric patient who have to undergo repeated general anesthesia.  There are currently less invasive techniques being studied to evaluate the esophagus which may play an important role in replacing repeated endoscopies for disease surveillance after treatment interventions.

If a patient has symptomatic and histologic remission (less than 15 eosinophils), a patient can be maintained on a PPI, reintroduction process to identify foods or maintenance topical corticosteroids.

If a patient has persistent symptoms and continual elevated eosinophils per high power field, the next steps would be:

  • rule out non-adherence
  • add ppi for uncontrolled reflux
  • further elimination diet or elemental diet
  • change to topical/systemic steroid
  • biologic therapy
  • esophageal dilation

Environmental allergens can trigger or exacerbate EoE.  EoE control might be improved by optimizing the management of concurrent asthma, allergic rhintis and eczema.  In this context, an allergist needs to treat the entire allergic person.

Other Conditions in Eosinophilic Esophagitis

Risk Factors for Eosinophilic Esophagitis

Eosinophilic Esophagitis in Southern California

 

 

Filed Under: Blog, eosinophilic esophagitis

alan-khadavi
Dr. Alan Khadavi
Allergy & Asthma Specialist

Latest Posts

November 16, 2023

Cranberry Allergy: Causes, Symptoms, and Management

cranberry allergy

November 14, 2023

Difelikefalin for Eczema, a potential new oral medication

difelikefalin

October 31, 2023

Pumpkin Allergy: Manifestations, Diagnosis, and Management

pumpkin allergy

October 23, 2023

Can I have a Caffeine Allergy?

caffeine allergy

October 11, 2023

Cinnamon Allergy: Symptoms, Diagnosis, and Management

cinnamon allergy

October 9, 2023

Black Pepper Allergy: Presentation, Diagnosis, and Management

black pepper allergy

October 3, 2023

Olive Allergy: An Overview of Clinical Presentation, Diagnosis, and Management

olive allergy

September 22, 2023

How to treat Eosinophilic Esophagitis (EoE)

eosinophilic esophagitis treatment

September 14, 2023

Barley Allergy: Diagnosis and Management

barley allergy

September 11, 2023

Can the Covid Vaccine cause Hives?

covid vaccine and hives

Read More Posts...

Follow Us…

© 2023 Allergy Los Angeles. All Rights Reserved · Log in · Return to top of page