Esophagitis treatment options
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Esophagitis Treatment Options: Overview and Key Approaches
Esophagitis, an inflammation of the esophagus, can be caused by various underlying conditions, including eosinophilic esophagitis (EoE) and lymphocytic esophagitis (LyE). Treatment strategies depend on the specific type and severity of esophagitis, with the main goals being symptom relief, disease control, and prevention of complications.
Eosinophilic Esophagitis (EoE) Treatment Options
Proton Pump Inhibitors (PPIs) for EoE
PPIs are commonly used as a first-line therapy for EoE due to their accessibility, safety, and ability to induce remission in about half of patients. They work by reducing inflammation, and their effects are not solely due to acid suppression. PPIs are often continued for maintenance in responders, but not all patients achieve remission with this approach 2456789.
Topical Corticosteroids for EoE
Swallowed topical corticosteroids, such as fluticasone and budesonide, are effective in inducing both symptomatic and histological remission in EoE. These medications are more effective than placebo, with a significant proportion of patients achieving histological improvement. Newer formulations designed to coat the esophagus have improved effectiveness and reduced dosing requirements 4567810.
Dietary Therapy for EoE
Dietary interventions, including elemental diets and empirical elimination diets (removing common food triggers), are effective in inducing remission. Step-up elimination diets (removing two or four foods rather than six) are recommended to minimize unnecessary restrictions and reduce the need for repeated endoscopies 245689.
Endoscopic Dilation for EoE
Endoscopic dilation is reserved for patients with esophageal strictures or persistent dysphagia despite medical therapy. It is effective in improving symptoms but does not address underlying inflammation, so it is usually combined with other treatments 24689.
Biologic and Emerging Therapies for EoE
Biologic therapies, such as monoclonal antibodies (e.g., mepolizumab, reslizumab, dupilumab), are being investigated for EoE, especially in patients who do not respond to standard treatments. These therapies target specific inflammatory pathways and have shown promise in improving histological outcomes, though their impact on symptoms is still being studied. Other investigational drugs include JAK-STAT blockers and S1PR agonists 345710.
Lymphocytic Esophagitis (LyE) Treatment Options
Proton Pump Inhibitors (PPIs) for LyE
PPIs are the most common initial therapy for LyE and can provide symptomatic relief. However, their effectiveness may be lower compared to topical steroids in terms of histological and symptomatic improvement .
Topical Steroids for LyE
Topical steroids, either as monotherapy or in combination with PPIs, have shown higher rates of symptomatic and histological improvement compared to PPIs alone. However, there may be a higher rate of symptom recurrence after stopping steroids .
Endoscopic Dilation for LyE
For patients with strictures, endoscopic balloon dilation can improve symptoms and resolve strictures in most cases, though some patients may experience recurrence .
Other Therapies for LyE
Other reported treatments for LyE include Vedolizumab, Botox injections, Sucralfate, and Tacrolimus, but data are limited and further research is needed to establish their effectiveness .
Conclusion
Treatment options for esophagitis, particularly EoE and LyE, include PPIs, topical steroids, dietary modifications, and endoscopic dilation. For EoE, biologic therapies and other novel agents are emerging as promising options, especially for refractory cases. For LyE, PPIs and topical steroids are the mainstays, with dilation reserved for strictures. Individualized treatment plans and further research are needed to optimize outcomes for all patients with esophagitis 12345678+2 MORE.
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