The goal of<unk>  treatment is to control the symptoms by decreasing the number of eosinophils in the esophagus and, subsequently, reducing the esophageal inflammation. Management consists of dietary, pharmacological, and endoscopic treatment. Dietary management Dietary treatment can be effective, as there does appear to be a role of allergy in the development of<unk> . Allergy testing is not particularly effective in predicting which foods are driving the disease process. If no specific allergenic food or agent is present, a trial of the six food elimination diet (SFED) can be pursued. Various approaches have been tried, where either six food groups (cow's milk, wheat, egg, soy, nuts and fish/seafood), four groups (animal milk, gluten-containing cereals, egg, legumes) or two groups (animal milk and gluten-containing cereals) are excluded for a period of time, usually six weeks. A "top down" (starting with six foods, then reintroducing) approach may be very restrictive. Four- or even two-group exclusion diets may be less difficult to follow and reduce the need for many endoscopies if the response to the limited restriction is good. Alternative options to SFED includes the elemental diet, which is an amino acid based diet. The elemental diet demonstrates a high rate of response (almost 90% in children, 70% in adults), with a rapid relief of symptoms associated with histological remission. This diet involves using amino-acid based liquid formulas for 4-6 wk, followed by the histological evaluation of response. If remission is achieved, foods are slowly reintroduced. Pharmacologic treatment In patients diagnosed with<unk> , a trial of PPI 20 mg to 40 mg oral daily or twice daily as a first line therapy is a reasonable option. Those who respond to PPI therapy with symptomatic improvement, should have endoscopy with esophageal biopsy should be repeated. If no eosinophils are present in the repeat biopsy, the diagnosis is either acid mediated GERD with<unk>  or non GERD PPI responsive<unk>  with unknown mechanism. If both symptoms and eosinophils persists after treatment with PPI, the diagnosis is immune mediated<unk> . Medical therapy for immune mediated<unk>  primarily involves using corticosteroids. Systemic (oral) corticosteroids were one of the first treatment options shown to be effective in patients with<unk> . Both clinical and histologic improvement have been noted in approximately 95% of<unk>  patients using systemic corticosteroids. However, upon discontinuation of therapy, 90% of patients using corticosteroids experience a recurrence in symptoms. Endoscopic dilatation In patients who present with food impaction, flexible upper endoscopy is recommended to remove impacted food. Dilation is deferred in<unk>  until patients are adequately treated with pharmacological or dietary therapy, and the result of a response to therapy is available. The goals of therapy for treating<unk>  is to improve the patient's symptoms as well as to reduce the number of eosinophils on biopsy. This procedure is effective in 84% of people who require it. Esophageal strictures and rings can be safely dilated in<unk> . It is recommended to use a graduated balloon catheter for gradual dilation. The patient should be informed that after dilation they might experience chest pain and in addition risk of esophageal perforation and bleeding.
Eosinophilic esophagitis
Gastroesophageal reflux disease
Herpes esophagitis
Coeliac disease
Lymphocytic esophagitis
Crohn's disease
Cytomegalovirus esophagitis
Eosinophilic granulomatosis with polyangiitis