Medicines that inhibit acid production in the stomach are often used for EoE, this class of medicines is called proton pump inhibitors and well-known examples are omeprazole, pantoprazole and esomeprazole. These medicines are also used for the treatment of reflux symptoms and can be used safely for a long time.
Corticosteroids can also be used in this type of treatment; these are generally used to form a thin layer in the esophagus and work directly (topical use) on the inflammation in the esophagus. There are melting tablets available with budesonide (Jorveza), this is an approved product in most of the European countries and has good effects in most patients. It has a longer contact time with the mucous membrane of the esophagus and therefore achieves somewhat better results. Budesonide is sometimes prepared by the pharmacy itself so it can be administered in liquid form together with a sweetener. This way the young child can take it without difficulty, since its viscosity slowly descends through the esophagus where it exerts its effect (viscous budesonide). Alternatively, asthma puffs are sometimes prescribed for swallowing instead of inhaling. This can work very well for EoE, but the puffs are not originally intended for this use and not officially approved for this application.

EoE medicines are usually taken after breakfast and dinner, before going to bed. You should not eat or drink for 30 to 45 minutes after taking them because this will cause the drug to pass too quickly into the stomach and not have time to work in the esophagus. Grapefruit and grapefruit juice should not be taken during treatment with budesonide as it prevents the functioning of an enzyme and risks unnecessarily prolonging the activity of this drug with the consequent increase in its side effects.

It includes three possibilities, depending on the age of the patient, his symptomatology, and other factors:

• The elemental diet, in which all foods are eliminated in their entirety and only one essential formula of nutrients is consumed. Some people call this type of food “astronaut feeding”. The elemental food can be used exclusively or in combination with other diets.
• The diet of exclusion of the foods with positive results in the allergic tests. (It is the diet with worse results obtained, at the moment this diet is not recommended. The EoE appears to follow a different immune response than that measured by food allergy tests).
• The empirical diet, which excludes those foods known to trigger the disease most often in most of the patients.

With any of the diets, there are three phases. In the first, a group of foods are eliminated for a maximum of 6 to 8 weeks, checking that the symptoms and eosinophils in the esophagus disappear.

Once the effectiveness has been proven (usually with biopsies taken with endoscopy), in the second phase the excluded foods would be introduced sequentially with clinical and endoscopic controls to identify the responsible food(s). In the third phase, it is recommended that the food(s) that trigger the EUS be excluded from the diet in a sustained manner.

The main advantage of dietary treatment is the possibility of maintaining the esophagus without inflammation in the long term, without the need for medication (swallowed corticosteroids), helping to avoid future complications. The disadvantage is that because the symptoms that cause the inflammation are not immediate and because they are not very clear and the same in all those who suffer from the disease, the process involves the need for multiple endoscopies. Sometimes up to 8 endoscopies are required in the period of a year’s time!

This treatment is recommended only in patients who have severe esophageal narrowing (strictures) and who do not respond to treatment with medicines or diet. Most of these patients are adults, although there are cases of children. This procedure, which is performed by means of gastroscopy, tries to produce a widening in the area that is narrowed. In all cases the dilation must be accompanied by medical treatment.