Steroids versus dietary therapy for the treatment of eosinophilic esophagitis

PURPOSE OF REVIEW: Eosinophilic esophagitis (EoE) is a condition characterized by dense mucosal eosinophilia in conjunction with symptoms of esophageal dysfunction. Since both the incidence and prevalence of EoE are on the rise in both children and adults, understanding the various treatment options available is imperative in choosing the proper treatment for each patient. This article will highlight the major strides in both medical and dietary treatment of EoE in the past year. RECENT FINDINGS: Whereas prior studies have shown that medical therapy with topical corticosteroids is effective in treating EoE, this more recent literature highlights some of the limitations of this approach, raising awareness that development of better drug delivery models is greatly needed. The review also describes the recent advances in the field of dietary therapy for this disease, particularly in adults, and further supports the notion that the pathophysiology of this disease in children and adults is similar, with food antigens driving this disease. SUMMARY: Both medical and dietary therapy are effective for treating adults and children with EoE. Choosing the optimal treatment approach should be individualized based both on patient goals and on available local resources. Future prospective clinical trials comparing these two treatment modalities are needed to help understand comparable effectiveness as well as to help understand potential predictors of response to treatment and identify optimal therapeutic endpoints.