Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis

Gastroenterology. 2020 Mar;158(4):840-851. doi: 10.1053/j.gastro.2019.09.052. Epub 2019 Dec 10.


Treatment of eosinophilic esophagitis has progressed from elemental formula for children and esophageal dilation for adults to selective exclusion of food triggers and swallowed topical corticosteroids. Management guidelines are available from the American Gastroenterological Association and the Joint Task Force on Allergy Immunology Practice Parameters. We cannot, however, evaluate the efficacy of treatments without a definition of response. We propose a treat-to-target approach, based on symptoms and findings from endoscopy and histology. This approach addresses dissociations between outcomes, such as symptom persistence despite normalization of histologic features and symptom resolution after esophageal dilation despite histologic features of active disease. Eosinophilic esophagitis can now be treated with biologic agents that target specific immune pathways, and findings from prospective trials have indicated that less-restrictive, empiric, elimination diets can be effective and reduce the need for repeated endoscopic assessment of disease activity during food reintroduction. We also discuss eosinophilic esophagitis subtypes, factors associated with disease, and advances in management.

Keywords: Dysphagia; Eosinophilic Esophagitis; Eosinophilic Gastroenteritis; Eosinophilic Gastrointestinal Disease; Gastroesophageal Reflux Disease.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Oral
  • Adolescent
  • Adult
  • Age Factors
  • Allergens / adverse effects*
  • Biological Products / administration & dosage
  • Child
  • Combined Modality Therapy / methods
  • Deglutition
  • Dietary Exposure / adverse effects
  • Dilatation / methods
  • Dilatation / standards
  • Environmental Exposure / adverse effects
  • Eosinophilic Esophagitis / diagnosis
  • Eosinophilic Esophagitis / etiology
  • Eosinophilic Esophagitis / pathology
  • Eosinophilic Esophagitis / therapy*
  • Esophagoscopy
  • Esophagus / diagnostic imaging
  • Esophagus / pathology
  • Feeding Behavior
  • Gastroenterology / methods*
  • Gastroenterology / standards
  • Glucocorticoids / administration & dosage
  • Humans
  • Infant
  • Practice Guidelines as Topic
  • Proton Pump Inhibitors / administration & dosage
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Allergens
  • Biological Products
  • Glucocorticoids
  • Proton Pump Inhibitors