• EoE is now the top cause of impacted food boluses (previously it was Schatzki rings). 

• EoE often relapses when off treatment. 

• Delaying diagnosis increases risk of future esophageal stricture. 

• 6 biopsies is preferred for diagnosis. 

• Greater than 15 eos/hpf makes the diagnosis. 

• Goal is to decrease eos down to less than 6/hpf. 

• PPI (bid is preferred) or poorly absorbed corticosteroids (PACS) like budesonide oral suspension 2 mg bid x 8-12 wks is still first line therapy. 

• After course of budesonide oral suspension (BOS) taper to the lowest effective dose, e.g., 0.5-1 mg qHS 

• Long-term use of topical steroids can be used to maintain remission 

• If BOS not covered or available, mix budesonide respules with honey to create your own slurry. 

• Dupixent 300 q week is second line therapy. 

• A 1 or 2 food elimination diet is a reasonable treatment strategy. 

• Milk is the most common food allergen to trigger EoE followed by wheat then eggs. 

• Elimination of milk and/or wheat will be effective in about 40% of cases. 

• Soy, nuts, and seafood account for a much smaller percentage (about 5% of cases each).  

• When in remission, do EGD every 2 yrs to survey. 

• Hope to have future testing to identify the specific food allergens triggering EoE in patients. 

• Patient support groups are available through organizations such as American Partnership for Eosinophilic Disorders (APFED).

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