EoE Management

There is no one preferred treatment for EoE. Goals and treatment preferences may differ based on age or lifestyle of the patient; therefore, the therapeutic approach should focus on shared decision-making.^1,2 This should occur each time treatment is adjusted, with follow-up endoscopy and re-evaluation planned as well (Figure 1). Shared decision-making is critical for supporting patients’ and helping them adhere to therapy and reach their treatment goals.³

The goals of treatment should be discussed and followed for each follow-up appointment, which are to minimize symptoms and endoscopic histopathologic features of EoE. Figure 2 shows a graphic representation of the difference between symptom maxima and minima. Overall, maximal symptoms include dysphagia with every meal despite a modified, soft-solid diet, and minimal symptoms include the complete absence of symptoms, the absense of endoscopic features of inflammation, an esophageal diameter of greater than 20 mm, and 0 eosinophils per high-powered field.¹

Effective treatment leads to normalization of disease features, and ineffective treatment does not.¹ The extent to which this paradigm will changes now that dupilumab has been approved by the Food and Drug Administration for adolescents and adults Do we need to mention that it’s now approved for children as young as 1 weighing at least 15 kg? with EoE has yet to be determined.

Management of patients with eosinophilic esophagitis (EoE), especially as treatment increasingly includes biologic therapy, is optimized when using a multidisciplinary approach.^5,6 For patients with EoE, this approach optimizes the continuum of care.

References

Hirano I, Furuta GT. Approaches and challenges to management of pediatric and adult patients with eosinophilic esophagitis. Gastroenterol. 2020;158(4):840-851. doi:10.1053/j.gastro.2019.09.05
Sher ER, Ross JA, Weine DW, Arjun AC. Current and emerging therapies for eosinophilic esophagitis. Allergy Asthma Proc. 2022;43:178-186. doi:10.2500/aap.2022.43.220014 For access to this entire article and additional high-quality information, please check with your college/university library, local public library, or affiliated institution.
Dellon, ES et al. ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol. 2025;120:31-59.
Chen JW. Management of eosinophilic esophagitis: Dietary and nondietary approaches. Nutr Clin Pract. 2020;35(5):835-847. doi:10.1002/ncp.10571
Chawla K, Alabbas B, Sheth D, Papademetriou M. As easy as EoE: A novel and effective multidisciplinary approach to care of patients with eosinophilic esophagitis in the age of biologics. Dig Dis Sci. 2020;65(8):2196-2202. doi:10.1007/s10620-020-06366-4
Sauer BG, West A, McGowan EC. Nutritional care in Multidisciplinary eosinophilic esophagitis care: A model for comprehensive patient-centered care through shared decision making between gastroenterology, allergy, and nutrition. Clin Gastroenterol Hepatol. 2021;19:2226-2229. doi:10.1016/j.cgh.2021.07.025