What Therapy to Use for Patients With EoE: PPIs, Steroids, or Elimination Diets?

What Therapy to Use for Patients With EoE: PPIs, Steroids, or Elimination Diets?

Prateek Sharma, MD, FASGE, reviewing Laserna-Mendieta EJ, et al. Clin Gastroenterol Hepatol 2020 Jan 25.

Proton pump inhibitors (PPIs), steroids, elimination diets, and esophageal dilation have all been evaluated with varying degrees of benefit in patients with eosinophilic esophagitis (EoE). This retrospective observational cohort study from Europe (EoE CONNECT database) attempted to describe the effectiveness (real-world setting) of PPIs, steroids, and diets in the treatment of EoE. 

Data were evaluated from 589 and 344 patients for the role of the above modalities as first-line and second-line treatments, respectively. PPIs were the most common first-line treatment (76.4%), followed by topical steroids (10.5%) and dietary therapies (7.8%). Topical steroids were the most effective (67.7%) in achieving histologic (≤15 eosinophils per high-power field) and clinical (-delta response in the dysphagia symptom score from baseline) response as compared to elimination diets (52%) and PPIs (50.2%) as first-line agents. Of the 344 patients who transitioned to second-line therapy, elimination diets (47.1%) were more common than PPIs (29.1%) or topical steroids (18.6%). Steroids also showed better effectiveness as a second-line agent (80.7%) compared to PPIs (69.2%) or elimination diets (41.7%). There were significant differences noted for choice of therapy (first-line and second-line), depending on the referral hospital or country of origin, but not for response to therapy.


In practice, PPIs are the most frequently prescribed first-line therapy for patients with EoE, although topical steroids appear to have the most benefit as both first- and second-line therapies. Elimination diets are the most favored second-line treatment approach for those failing the initial therapy for EoE. Although this study shows some interesting trends, there is still a need for randomized head-to-head controlled trials and newer agents before making changes to the landscape of EoE therapy.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Prateek Sharma, MD, FASGE


Laserna-Mendieta EJ, Casabona S, Savarino E, et al; EUREOS EoE CONNECT Research Group. Efficacy of therapy for eosinophilic esophagitis in real-world practice. Clin Gastroenterol Hepatol 2020 Jan 25. (Epub ahead of print) (https://doi.org/10.1016/j.cgh.2020.01.024)

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