Table of Contents
Overview of Current Treatments for Eosinophilic Esophagitis
Dietary Interventions
Dietary modifications are a cornerstone of EoE management. The most commonly employed strategies include elimination diets, wherein specific food allergens are removed from the patient’s diet to reduce eosinophilic inflammation. Studies have shown that the six-food elimination diet (eliminating wheat, milk, eggs, soy, nuts, and seafood) can lead to significant histological and symptomatic improvements (Dellon et al., 2018).
Moreover, elemental diets, which consist of amino acid-based formulas, have also demonstrated efficacy in achieving remission in patients with EoE (Spergel et al., 2018). However, adherence to strict dietary protocols can be challenging, and patients often require ongoing support and education to maintain compliance.
Pharmacological Treatments
Pharmacotherapy for EoE primarily involves the use of topical corticosteroids, such as fluticasone or budesonide. These medications can effectively reduce inflammation and eosinophil counts in the esophagus. A meta-analysis indicated that topical corticosteroids lead to histological remission in approximately 70% of patients (Lucendo et al., 2017). Proton pump inhibitors (PPIs) are also commonly used, particularly for those with concomitant gastroesophageal reflux disease (GERD), although their efficacy in EoE is variable (Dellon, 2020).
Endoscopic Interventions
For patients presenting with strictures or significant dysphagia, endoscopic dilation may be indicated. This procedure involves mechanically widening the esophagus to alleviate obstruction. While dilation can provide symptomatic relief, it does not address the underlying eosinophilic inflammation and is often combined with medical therapy for comprehensive management (Schoepfer et al., 2010).
Role of Traditional Chinese Medicine in Eosinophilic Esophagitis
Traditional Chinese Medicine (TCM) offers a holistic approach to treating EoE through the use of herbal formulations, acupuncture, and dietary therapy. TCM emphasizes the regulation of the immune system and the restoration of balance within the body. Active ingredients from TCM, such as astragaloside and curcumin, have shown promise in modulating immune responses and enhancing the efficacy of conventional treatments (Zheng et al., 2025).
For instance, astragaloside IV has been found to inhibit eosinophil activation and promote immune cell function, which may complement the effects of corticosteroids in EoE management (Chen et al., 2024). Incorporating TCM strategies may not only reduce eosinophilic inflammation but also improve patients’ overall quality of life.
Integrating Novel Therapies with Conventional Treatments
Recent advancements in immunotherapy, particularly monoclonal antibodies like dupilumab, have revolutionized the treatment landscape for EoE. Dupilumab targets interleukin-4 and interleukin-13 pathways, effectively reducing inflammation and promoting clinical remission (Hirano et al., 2020). The combination of dupilumab with TCM approaches may enhance treatment outcomes by addressing both the immune dysregulation and the inflammatory processes inherent to EoE.
It is essential to tailor treatment plans to individual patient needs, considering the specific phenotypic characteristics of EoE, comorbidities, and patient preferences. A multidisciplinary approach that includes gastroenterologists, allergists, nutritionists, and TCM practitioners can optimize therapeutic outcomes.
Addressing Knowledge Gaps in Eosinophilic Esophagitis Management
Despite advancements in EoE management, significant knowledge gaps remain. For instance, the precise mechanisms underlying EoE pathogenesis are not fully understood, and there is limited data on the long-term efficacy and safety of emerging therapies. Further research is needed to establish clear guidelines for the diagnosis, treatment, and follow-up of patients with EoE, particularly in diverse populations.
Additionally, educating healthcare providers about the latest developments in EoE management is crucial. Enhanced training and resources can improve recognition and treatment of EoE, ultimately leading to better patient outcomes.
Conclusion
Eosinophilic esophagitis requires a comprehensive management strategy that incorporates dietary modifications, pharmacotherapy, and potentially endoscopic interventions. The integration of traditional Chinese medicine and novel therapies such as dupilumab may offer synergistic benefits in treating this complex condition. By addressing current knowledge gaps and fostering multidisciplinary collaboration, healthcare providers can enhance the quality of care for patients with EoE.
References
- Aceves, S. S., & Dellon, E. S. (2019). Current state of biologics in treating eosinophilic esophagitis. Ann Allergy Asthma Immunol, 123(2), 166-172. https://doi.org/10.1016/j.anai.2019.04.010
- Chen, Y., Li, J., & Wang, Y. (2024). Potential of astragaloside IV in eosinophilic esophagitis treatment: A comprehensive review. Pharmaceutics, 16(4), 487. https://doi.org/10.3390/pharmaceutics16040487
- Dellon, E. S., & Hirano, I. (2018). Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology, 154(2), 319-332.e3. https://doi.org/10.1053/j.gastro.2017.06.067
- Hirano, I., Dellon, E. S., & Liacouras, C. A. (2020). AGA institute and the joint task force on allergy-immunology practice parameters clinical guidelines for the management of eosinophilic esophagitis. Ann Allergy Asthma Immunol, 124(5), 416-423. https://doi.org/10.1016/j.anai.2020.03.020
- Lucendo, A. J., et al. (2017). Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol, 14(1), 13-22.e1. https://doi.org/10.1016/j.cgh.2015.07.041
- Schoepfer, A. M., et al. (2010). Esophageal dilation in eosinophilic esophagitis: effectiveness, safety, and impact on the underlying inflammation. Am J Gastroenterol, 105(5), 1062-1070
- Zheng, H., et al. (2025). Integration of active ingredients from traditional Chinese medicine with nano-delivery systems for tumor immunotherapy. J Nanobiotechnology, 14, 2. https://doi.org/10.1186/s12951-025-03378-y
FAQ
What is eosinophilic esophagitis?
Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by eosinophilic infiltration in the esophagus, often leading to symptoms like dysphagia and food impaction.
What are the main treatment options for EoE?
Main treatment options include dietary interventions, topical corticosteroids, proton pump inhibitors, and endoscopic dilation for strictures.
How does traditional Chinese medicine contribute to EoE management?
Traditional Chinese medicine can modulate immune responses through herbal ingredients, potentially enhancing the effectiveness of conventional treatments.
What is the role of dupilumab in EoE treatment?
Dupilumab is a monoclonal antibody that targets interleukin-4 and interleukin-13 pathways, showing significant efficacy in reducing inflammation and improving clinical outcomes in EoE patients.
Are there any knowledge gaps in EoE management?
Yes, there are ongoing challenges related to the long-term efficacy of treatments, the understanding of EoE pathogenesis, and the need for improved educational resources for healthcare providers.
