- Ongoing research is focused on bringing new treatments and methods of diagnosis to people with eosinophilic esophagitis (EoE).
- Recently, dupilumab received the first approval from the U.S. Food and Drug Administration (FDA) to treat EoE specifically.
- Researchers are studying less invasive ways to diagnose EoE, like using ultrasound or nitric oxide.
Recent scientific advances in treatment have led to the first FDA-approved therapy for eosinophilic esophagitis. This is an exciting development for those living with EoE, an inflammatory disease that affects the esophagus and gastrointestinal tract.
EoE is associated with symptoms such as narrowing of the esophagus (strictures), food getting stuck in the throat (food impaction), and abdominal or chest pain. Research studies show that EoE also largely affects the mental health of those living with the condition. This finding highlights the need for more research and development of treatments that improve quality of life.
Keeping up to date on the newest studies can help you stay informed on new treatments and findings in the field you can discuss with your doctor. As research continues to look into new therapies, there may be opportunities to try these treatments for yourself.
Traditional Treatments for Eosinophilic Esophagitis
EoE is an immune system disorder in which specialized white blood cells, known as eosinophils, collect in the esophagus tissue. This causes inflammation and swelling, making it difficult to swallow (known as dysphagia). Researchers are not quite sure what causes EoE, but they believe it may be related to food allergies or a response to an allergen in the environment.
Traditionally, EoE treatment has focused on reducing the symptoms of the condition rather than targeting its cause. Proton pump inhibitors (PPIs) are primarily used to treat heartburn caused by gastroesophageal reflux disease (GERD). PPIs are often the first therapy tried to help people with EoE.
Topical corticosteroids can also be used if PPIs do not work. Two treatment options are budesonide or fluticasone, which come in a liquid form and are swallowed to help treat inflammation in the esophagus. Dietary therapy is also used to help treat EoE by addressing the potential food allergy component. One example is following the elimination diet, in which you stop eating foods that commonly cause allergies to see if your symptoms improve. A procedure called esophageal dilation is sometimes used to help ease the symptoms of EoE.
Dupilumab Approved for Treating Eosinophilic Esophagitis
Although traditional treatments can be effective for managing symptoms, they do not help address the cause of EoE. Researchers and health care providers continue to investigate new therapies to treat inflammation at its source.
On May 20, the FDA approved the medication dupilumab (Dupixent) for treating pediatric EoE in children and adolescents 12 years and older and adults who weigh at least 88 pounds. This is the first-ever treatment FDA approved for EoE specifically, highlighting an exciting advancement in the field. Dupilumab was originally approved by the FDA in 2017 for treating moderate to severe atopic dermatitis (eczema) in children and adults.
Because EoE is an allergic condition involving the immune system, researchers have found that directly targeting the source of inflammation helps treat it. Dupilumab is a treatment known as a biologic. It uses human-made antibodies (known as monoclonal antibodies) that act on the immune system to dampen inflammation. Specifically, dupilumab works by blocking the effects of proteins called cytokines that are released by eosinophils.
Dupilumab Clinical Trial Results
Dupilumab was studied in a randomized phase 3 clinical trial for 24 weeks. Study participants were divided into parts A and B and received either 300 milligrams of dupilumab or a placebo every week during the trial. Researchers measured how well the treatments worked by looking at eosinophil levels in the esophagus under a microscope. They also had participants fill out the Dysphagia Symptom Questionnaire (DSQ) to measure if their dysphagia improved throughout the study.
Overall, 60 percent of participants from part A who received dupilumab met the study goal of reduced eosinophil levels in the esophagus, compared to only 5 percent from the placebo group. The dupilumab group also improved their DSQ score by 22 points, compared to only 10 points in the placebo group.
Participants from part B saw similar results — 59 percent of those who received dupilumab met the study goal of reduced eosinophil levels, compared to 6 percent with placebo. The dupilumab group also improved their DSQ scores by 24 points, compared to only 14 points from the placebo group.
By far, the most common side effect of dupilumab is a reaction at the injection site. Upper respiratory tract infections may also occur. Other, more rare side effects (experienced by less than 3 percent) noted during the research included joint pain and viral infections with a herpes virus.
Treatments Currently Under Investigation
Other treatments currently being studied in clinical trials for EoE include tezepelumab, benralizumab, and cendakimab. Tools for better diagnosis are also being studied, such as improved ultrasound for detecting EoE.
Tezepelumab is another monoclonal antibody drug that targets a different part of the immune system than dupilumab. It blocks a specific cytokine known as thymic stromal lymphopoietin, which plays a role in different inflammatory conditions such as chronic obstructive pulmonary disease and asthma.
Tezepelumab was given Orphan Drug Designation (ODD) status by the FDA in 2021. The name ODD is given to drugs being researched for treating rare diseases (those that affect fewer than 200,000 people in the U.S.). There are currently no clinical trials that study tezepelumab for treating EoE specifically, but the drug has completed trials for treating asthma.
Benralizumab (Fasenra) is another monoclonal antibody drug that was given ODD status by the FDA in 2019. Cytokines, which send signals for inflammation in the body, work by binding to receptors on the outside of cells. When they bind, they create more inflammation signals to send to other cells. Benralizumab works by attaching itself to the receptor, which blocks the cytokine from binding and sending signals. This process dampens inflammation, which is useful for treating conditions like EoE. Benralizumab blocks signals from the cytokine called interleukin-5.
Benralizumab is already FDA approved as an injectable pen for treating asthma — however, it is not yet approved for treating EoE. One active phase 3 clinical trial is currently studying this medication for treating EoE, and it is set to end in mid-2024. If the results of the trial are positive, the drug may be approved.
Cendakimab is a third antibody drug that also blocks cytokines binding to its receptor. The FDA gave cendakimab ODD status in 2015, and it has since been studied for treating EoE. Some early clinical trials show that this drug reduces EoE and helps some people reach remission (a decrease in or disappearance of signs and symptoms). Researchers are currently recruiting for a phase 3 clinical trial studying cendakimab as maintenance therapy in people with EoE.
New Diagnostic Methods
Researchers are also interested in coming up with new ways to diagnose gastrointestinal diseases like EoE. Currently, EoE is diagnosed with endoscopy and biopsy, which can be expensive and invasive. With this in mind, many clinical trials have investigated the amount of nitric oxide exhaled by people with EoE and those without. Specialized medical devices are used to measure the concentration of nitric oxide that a person breathes out, which can be used to diagnose EoE.
The Mayo Clinic is also hosting a clinical trial using a special type of ultrasound imaging to look at the esophagus and blood vessels in people with EoE. This would be a less invasive method than endoscopy for diagnosis and could potentially have a significant impact on diagnosing pediatric EoE.
Talk to Your Doctor About New Treatments
If you are interested in trying a newly approved treatment like dupilumab or want to join a clinical trial, talk to your doctor. They will likely be up to date on studies investigating treatments for gastrointestinal disorders like EoE and can give you recommendations.
Find Your Team
On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to gain a new understanding of EoE and share their stories with others who understand life with EoE.
Have you tried dupilumab to treat your EoE? Has your doctor recommended trying an investigational drug? Share your experiences in the comments below.
- Eosinophilic Esophagitis — MedlinePlus
- Eosinophilic Esophagitis — Mayo Clinic
- Distinguishing GERD From Eosinophilic Oesophagitis: Concepts and Controversies — Nature Reviews Gastroenterology & Hepatology
- Use of Dietary Strategies in Treating Eosinophilic Esophagitis — Mayo Clinic
- FDA Approves First Treatment for Eosinophilic Esophagitis, a Chronic Immune Disorder — U.S. Food and Drug Administration
- What Are “Biologics” Questions and Answers — U.S. Food and Drug Administration
- Efficacy of Dupilumab in a Phase 2 Randomized Trial of Adults With Active Eosinophilic Esophagitis — Gastroenterology
- Study to Determine the Efficacy and Safety of Dupilumab in Adult and Adolescent Patients With Eosinophilic Esophagitis (EoE) — ClinicalTrials.gov
There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.What is the most effective treatment for eosinophilic esophagitis? ›
Your provider will likely first prescribe an acid blocker such as a PPI . This treatment is the easiest to use, but most people's symptoms don't improve. Topical steroid. If you do not respond to the PPI , your provider will then likely prescribe a steroid, such as fluticasone or budesonide.What is the natural treatment for EoE? ›
Natural treatments may help control the symptoms, but they won't cure eosinophilic esophagitis. Some herbal remedies such as licorice and chamomile may help acid reflux symptoms. Acupuncture and relaxation techniques like meditation can also help prevent reflux.Can eosinophilic esophagitis go into remission? ›
Eosinophilic esophagitis (EoE) is a chronic disorder characterized by remissions and relapses. The goals of therapy in clinical care and research are to reduce eosinophil density below the threshold value for diagnosis, i.e. 15 eosinophils per high power field (HPF), and to reduce symptoms.Can you live a long life with EoE? ›
Eosinophilic esophagitis (EoE) is a chronic disease that can be diagnosed at any age, but is not associated with malignancy and does not shorten lifespan.Does EoE reduce life expectancy? ›
Based on what is known to date, eosinophilic esophagitis does not cause cancer of the esophagus and is not thought to limit life expectancy in any way. Current information suggests if left untreated, EoE may lead to esophageal narrowing over time.What foods heal esophagitis? ›
Use high protein, thick liquids and higher calorie items, such as milkshakes, custard, pudding, macaroni and cheese, etc. Some other soft or liquid-‐type foods are applesauce, cooked cereals, strained cream soup, mashed potatoes, Jello, rice pudding, etc.What is the most common cause of eosinophilic esophagitis? ›
Causes. EoE is caused by an allergic reaction to certain foods or environmental allergens.Can allergy shots help eosinophilic esophagitis? ›
Multiallergen subcutaneous immunotherapy might be a safe and effective option for patients with eosinophilic esophagitis and comorbid allergic rhinitis and/or asthma who do not respond to standard therapies, though future controlled studies are needed.What helps heal the esophagus? ›
These include antacids (Maalox, Mylanta, others); medicines that reduce acid production, called H-2-receptor blockers, such as cimetidine (Tagamet HB); and medicines that block acid production and heal the esophagus, called proton pump inhibitors.
Although research is ongoing, ginger may also help lower eosinophils. To reap the benefits, take ginger supplements daily or brew ginger tea. The majority of grocery stores sell ginger tea. Put the tea bag in a cup and pour it with hot water.What foods make EoE worse? ›
Multiple studies have found milk (60 percent) and wheat (30 percent) to be the most common food triggers.How many people suffer from eosinophilic esophagitis? ›
Prevalence and Consequences: EoE prevalence has increased over the past 2 decades, nearly doubling in both adults and children, and occurring in an estimated one in 1,500 to 2,000 persons. EoE affects more adults than children (19.1 cases/100,000 vs.What percent of people have eosinophilic esophagitis? ›
The frequency of eosinophilic esophagitis has been estimated to be approximately 1 in 2,000 individuals. This condition has been reported in multiple continents including Europe, Australia, and America.Does stress affect eosinophilic esophagitis? ›
Increased stress can worsen symptoms.What is the death rate of eosinophilic esophagitis? ›
In the EoE group, 34 deaths were confirmed (4.6 per 1,000 person-years) compared with 165 in population comparators (4.57 per 1,000 person-years) (Table 2).Does EoE run in families? ›
Researchers think that eosinophilic esophagitis may have a genetic component because the condition sometimes runs in families. If your family members have eosinophilic esophagitis, you have a greater chance of being diagnosed.
Chest pain is one of the symptoms for EoE, but it can also be accompanied by coronary heart disease.Is EoE considered a rare disease? ›
Eosinophilic esophagitis is a rare disease, but increasing in prevalence with an estimated 1 out of 2,000 people affected. EoE affects people of all ages and ethnic backgrounds.Is EoE a progressive disease? ›
Eosinophilic esophagitis (EoE) is a chronic, progressive, type 2 inflammatory disease of increasing prevalence, characterized by symptoms of dysphagia and reduced quality of life.
Drinking water, low fat milk, and herbal teas may help manage it. Alcohol, caffeinated drinks, and sodas may worsen symptoms, however. Acid reflux, or heartburn, occurs when stomach acid flows up into a person's esophagus, or food pipe. It is common for people to experience acid reflux intermittently.What vitamin helps esophagitis? ›
In fact, one study found that increased intake of several B vitamins was associated with a lower risk of reflux esophagitis, a condition characterized by inflammation in the esophagus often caused by acid reflux ( 8 ).
2. Bananas. This low-acid fruit can help neutralize stomach acid by coating an irritated esophageal lining. And not only are bananas alkaline, they're also rich in pectin — a soluble fiber that helps keeps food flowing nicely through the digestive tract.What illness causes eosinophilic esophagitis? ›
Eosinophilic Esophagitis: Food Allergies
Adverse immune responses to food are the main cause of EoE in a large number of patients. Allergists are experts in evaluating and treating EoE related to food allergies. However, the relationship between food allergy and EoE is complex.
Bacterial growth was identified to the species or genus level. The major part of bacterial groups or species was found in specimens from the lower oesophagus in EoE subjects compared to GERD subjects. Streptococcus viridans was the most common bacteria in both groups.Does Benadryl help with eosinophilic esophagitis? ›
o Carry injectable epinephrine (Epi-Pen or Autoinjector) and an oral antihistamine such as Benadryl as prescribed for emergencies. If EoE is aggrevated by gastroesophageal reflux, treating the reflux may help the EoE. This may include medication, lifestyle, physical and dietary measures to decrease reflux.Does Flonase help eosinophilic esophagitis? ›
When fluticasone propionate is swallowed, it has been shown to reduce the eosinophils in the esophagus and relieve dysphagia in patients with eosinophilic esophagitis.Does Benadryl treat EoE? ›
Does Benadryl Relieve Eosinophilic Esophagitis? Benadryl, a diphenhydramine formulation, is an antihistamine acting against allergies. It was not found effective against eosinophilic esophagitis.Can the esophagus lining repair itself? ›
As a result, the esophagus tries to repair itself from inflammation or ulceration by repairing the original cell lining. In 12% of patients, this replacement lining will not be the original type found in the esophagus, but more like that of the stomach.Does drinking water help esophagitis? ›
This can help prevent acid reflux symptoms. According to a 2019 case study , frequent sips of water can help clear acid from the esophagus. Beverages such as coffee, soda, and acidic juices may increase the risk or severity of reflux symptoms.
Some people with esophagitis do well with soft scrambled eggs or egg substitutes. If the esophagus is irritated as a symptom of an underlying illness, or from the treatment of an illness, it is especially important for patients to maintain good nutrition and body weight to regain and stay in good health.Which fruit is good for eosinophilia? ›
- Vegetables (nonlegume): carrots, squash, sweet potato, white potato, string beans, broccoli, lettuce, beets, asparagus, cauliflower, Brussel sprouts.
- Fruit (noncitrus, nontropical) apples, pear, peaches, plum, apricot, nectarine, grape, raisins.
Conclusion. Vitamin D deficiency was associated with higher blood eosinophil count. These results support the possible role of vitamin D in the eosinophil immune response.Is coffee good for eosinophils? ›
In group 5 the caffeine increased the number of neutrophils 2.7-times and increased the number of eosinophils 4.6-times (P < 0.05) compared with control. Our study revealed that caffeine played an important role in the development of protective immune response.What foods to avoid eosinophils? ›
Avoid all forms of fish and shellfish including fish sauce and oyster sauce. Read food labels and avoid foods that 'may contain' fish or shellfish. The following tables will show you what you can and can't eat while on the 6FED, avoiding wheat (W), milk (M), eggs (E), soy (S), nuts (N) and fish/shellfish (F).Are potatoes bad for EoE? ›
The most common food triggers for EoE include milk, eggs, wheat, soy, peanuts, corn, potato, rice, oat, barley and meat (beef, chicken, and pork). People with EoE may have other nonfood allergies.What breakfast food goes with EoE? ›
- Pumpkin Pie Chia Pudding - Hungry by Nature. ...
- Looking for a healthy breakfast idea? ...
- healthy flourless banana pancakes (gluten free, vegan) ...
- Strawberries and Cream Overnight Oats. ...
- Strawberry Banana Oatmeal Breakfast Smoothie Recipe | Yummly. ...
- Homemade Instant Oatmeal.
The average age at diagnosis ranges between 30 and 50 years and suggests that EoE is a disease of the middle-aged man. It can affect patients of every race, but the disease is more common among Caucasians.Can I claim disability for EoE? ›
To get a disability rating from VA, you must prove a service connection for your condition. This requires having a current diagnosis for EoE, an in-service event or stressor which caused the condition, and a medical nexus—or proof of the connection from a medical profession—to make your case.Can EoE patients ever add foods back in? ›
After about 8 weeks on a formula-only diet, your doctor will do an endoscopy to see if your eosinophil levels have gone down. If so, you'll slowly add foods back into your diet while your doctor monitors your body's response. The elemental diet is the most effective dietary approach to EoE.
Eosinophilic esophagitis (EoE) is an emerging disease that appears to be increasing in prevalence, affecting approximately 1/1000 people in the U.S.(1) It has recently been reported that individuals with EoE have an increased prevalence of Autism Spectrum Disorder (ASD) and developmental delay.What percent of the population has EoE? ›
Prevalence and Consequences: EoE prevalence has increased over the past 2 decades, nearly doubling in both adults and children, and occurring in an estimated one in 1,500 to 2,000 persons.How much of the population has EoE? ›
The frequency of eosinophilic esophagitis has been estimated to be approximately 1 in 2,000 individuals. This condition has been reported in multiple continents including Europe, Australia, and America.
Eat a healthy diet free of acidic foods: Both acid reflux and heartburn can raise your body's eosinophil count. To avoid these conditions, one must eat a balanced, healthy diet. Look for low-fat foods, including lean meats, whole grains, fresh fruits and vegetables, and whole-grain foods.What are the most common EoE food triggers? ›
Research shows a strong connection between food allergies and eosinophilic esophagitis (EOE). These six foods are most commonly associated with this allergic response: dairy, wheat, soy, eggs, nuts, and seafood/shellfish.Does EoE count as a disability? ›
With eosinophilic esophagitis, a veteran may be eligible if they are awarded the 60 percent rating, OR if their rating for eosinophilic esophagitis helps them reach a combined rating of 70 percent. Veterans who do not meet these qualifications may be eligible for extraschedular TDIU.What are people with EoE allergic to? ›
The foods that most commonly cause an allergic reaction leading to EoE include milk, eggs, wheat, soy, peanuts or tree nuts and fish or shellfish. You may have a combination of allergies that increase the risk of EoE.Why is EoE on the rise? ›
What Causes EoE? According to Dr. Gramling, the rise in EoE cases found in children is likely due to increasing allergies of all types and improved awareness about the disorder.