Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that can cause trouble swallowing — also referred to as dysphagia — and food impaction, or food getting stuck. These symptoms can send people with EoE to the emergency room. If EoE isn’t diagnosed early and treated effectively, it can lead to complications like strictures (areas of scarring that narrow the throat).

An empiric elimination diet (a six-food elimination diet that excludes milk, eggs, soy, wheat, nuts, and fish) can improve symptoms and decrease inflammation. However, this type of diet can also be costly and hard to stick to. Since the number of people with EoE is rising, it’s more important than ever to find new and more effective ways to treat it.

To find out more about recent advances in the treatment of EoE, myEoEcenter spoke with Dr. Anisa Shaker, a gastroenterologist and associate professor of medicine at the Keck School of Medicine of University of Southern California in Los Angeles. Dr. Shaker has many years of experience treating people with swallowing and esophageal disorders, including EoE.

How EoE Has Been Treated

Until recently, there were only three main treatment options for EoE, which people might use separately or in combination.

“Patients really only had choices that were limited to dietary elimination, so avoiding certain food triggers, which could be and can be very cumbersome for patients to follow,” said Dr. Shaker. “We also had the option of treating patients with medications, a class of medications known as proton pump inhibitors. And then up until recently, we were using a steroid formulation that patients actually had to concoct by themselves to make it into a type of slurry so when they swallowed it, it would coat the inner lining of the esophagus.”

Finding the Cause of Inflammation

Developing better treatments for a condition often starts with learning more about what’s causing it.

“For the longest time, patients and their doctors were unaware of this disease,” explained Dr. Shaker. “All that they knew was that food was getting stuck. Now we know an abnormal inflammation in the esophagus is causing those symptoms.” (The esophagus is the tube that carries food and liquids from the mouth to the stomach.)

Dr. Shaker continued, “Because we have a better understanding of what’s causing that inflammation, we are coming up with more and more types of therapies to treat that inflammation in a way that really does not impact the lifestyle of our patients or has minimal impact on the lifestyle of the patient, and at the same time effectively treats the disease and prevents complications.”

“Because we have a better understanding of what’s causing inflammation, we are coming up with more and more types of therapies to treat it.”

— Dr. Anisa Shaker

She summarized, “One of the best and most important things that patients can do is to get their inflammation under control, aAnd that is often done with medical therapy.”

3 Recent Advances in EoE Treatment

Several medications have recently been approved by the U.S. Food and Drug Administration (FDA) to treat EoE. Dr. Shaker explained why this is important for better outcomes and quality of life. For a long time, people with EoE had to rely on off-label medications — drugs approved for other conditions but not for EoE.

However, recent advancements have changed that. “In the past one to two years, there’s been several advances in the therapies that are available for our patients,” she said. “I’m really excited about three advances in the care of patients with EoE.”

1. The First Biologic Medication for EoE

One of the FDA-approved drugs for EoE is a biologic that targets the inflammatory pathways that are most involved with the condition, according to Dr. Shaker. Biologics are medications made from proteins or other molecules that are initially found in blood or other living systems, then made in large quantities in laboratories.

The drug, Dupixent (dupilumab), is administered as a subcutaneous (under the skin) treatment, generally once a week. “It’s been shown to be effective in patients that have not responded to other types of therapies, for instance, proton pump inhibitors. It’s quite well tolerated by most patients,” said Dr. Shaker.

2. An Oral Steroid That Comes in Slurry Form

Dr. Shaker also expressed excitement about the approval of budesonide (Eohilia), which comes in an easy-to-swallow form. “This one is an oral steroid in the form of a slurry, so that when you take this medication, it coats the lining of your feeding tube or esophagus, the organ that is affected in eosinophilic esophagitis,” she said.

“There’s a lot of hope for our patients, and also much better understanding for their caregivers and their physicians.”

— Dr. Anisa Shaker

Although steroids were already used to treat EoE, having a prepackaged slurry makes for a more convenient treatment option rather than having to prepare the slurry for each dose. “Patients just open it up and swallow it,” said Dr. Shaker.

3. A Steroid Tablet That Dissolves on the Tongue

Finally, Dr. Shaker expressed optimism for a treatment that’s still under investigation. Currently called APT-1011, it’s a formulation of fluticasone propionate, a type of synthetic corticosteroid. It comes in the form of a tablet that disintegrates on the tongue, without water. When swallowed, it coats the esophagus.

“Patients are always excited about therapy that does not impact their lifestyle,” Dr. Shaker said. “This drug is still undergoing study, but early results are promising.”

Further clinical trials will be needed to establish whether the pill is a safe and effective treatment for people with EoE.

Improved Outlook for People With EoE

Dr. Shaker is often asked by her patients what the long-term outlook is for eosinophilic esophagitis. What will life look like for them in the future?

“I’m very encouraged to say that the long-term outlook is quite good, particularly in patients who have been treated and who are undergoing treatment,” said Dr. Shaker. “There’s a lot of hope for our patients, and also much better understanding for their caregivers and their physicians.”

Talk About EoE Treatment Options With Your Doctor

With new therapies available, it’s a good time for people with EoE to talk to their health care providers about their treatment options and goals.

“The important thing is to treat EoE, because if the inflammation remains untreated, it can lead to scarring. That can be difficult to manage.”

— Dr. Anisa Shaker

“The ultimate goal for our patients with eosinophilic esophagitis is that they have minimal impact on their lifestyle, that we get their inflammation under such good control that they can enjoy food with their friends and family without any kind of fear of food being stuck,” said Dr. Shaker.

“We have a lot of new therapies that are available for treating this disease,” she said. “The important thing is to treat EoE, because if the inflammation remains untreated, it can lead to scarring. That can be difficult to manage.”

Find Others Who Understand

On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn about EoE and share their stories with others who understand life with EoE.

Are you interested in learning more about recent advances in EoE treatment? Have you talked to your gastroenterologist or allergist about newer treatment options? Share your experience in the comments below.