July 12th, 2010
I’m back! So how do you treat eosinophilic esophagitis?
Eosinophilic esophagitis has been around for a long time but we only recently have recognized it and begun to try and treat it. My dilemma has been how and for how long should I treat this patient. Part of the decision difficulty lies in the extreme variation of clinical presentation that I see in this disease and part is related tot he lack of good quality treatment information.
For example, do we treat all patients with topical steroids (inhaled steroids that are swallowed) and if so for how long (intermittent courses, maintenance long-term therapy, once)? Or are some better treated with other anti-inflammatory products? Treat first, dilate after or dilate then treat? What is the role for dietary modification in adult patients?
So I am asking you to weigh in one these issues:
Do you treat all adult patients with newly diagnosed eosinophilic esophagitis with oral inhaled then swallowed steroids (fluticasone)?
If so how long?
In those with a stricture or narrowed esophagus do you dilate first then treat or treat then dilate?
If you do not use steroids or they fail, what do you use to treat eosinophilic esophagitis?
Let me know what you do, I look forward to hearing from you.