Currently, there is no one accepted therapy for all patients with EoE. Although dietary therapy is the most common treatment of pediatric EoE, this has not been widely accepted among gastroenterologists who treat adult patients. Many adult patients are initially treated with acid-blocking medications to rule out GERD. If this does not improve symptoms or tissue changes of the eosinophils, then steroids taken using an asthma inhaler, but swallowed rather than inhaled by the patient, have been tried with good, although limited results. This treatment tends to be well tolerated; side-effects of a fungal infection called thrush or candida of the esophagus are relatively rare.
Dietary treatment may consist of an elemental diet, a "six-food-elimination diet" or a targeted-elimination diet, usually for six weeks. After this point, if the disease improves, foods are reintroduced one at a time to help identify the food trigger. An elemental diet is another potential treatment. It is an amino-acid based formula, taken usually for six weeks. Elemental formula can have a poor taste and can be costly; therefore, a six-food-elimination diet is preferred by most patients. A six-food-elimination diet is a diet that contains no milk, soy, egg, wheat, nuts or seafood. These foods are the most common food allergens found in patients with EoE. A targeted-elimination diet is a diet that is based on eliminating foods found to be positive on allergy testing.
Dietary therapy has been shown to be helpful in some adults with EoE and may be tried with motivated (willing to follow through with food avoidance) patients under the care of an experienced provider or dietician.
If patients do not respond to medical therapy or diet exclusion, an esophageal dilation or "stretching" is sometimes performed if there is narrowing of the esophagus. Although dilation may be helpful in the short term, repeated dilations may be needed to control symptoms. Because dilation alone does not affect the underlying inflammation in the esophagus, this procedure is usually performed in patients who are also being treated with medical or dietary therapy. The risks of esophageal dilation include chest pain after the procedure and in rare cases a perforation or tear of the esophagus. While dilation can be performed safely, it must be done with caution and is almost always performed after a trial of medical or dietary therapy has failed.