Patient handout

Eosinophilic Esophagitis

PRODUCTION

1. Your condition

This handout is for eosinophilic esophagitis. Your care team identified this based on: dysphagia to solids ± food impaction in adolescent/adult (aga-jtf 2020).

Other reasons your team may use this plan: food bolus impaction requiring endoscopic removal (aga-jtf 2020); refractory reflux / heartburn not responding to ppi (aga-jtf 2020); esophageal biopsy ≥15 eosinophils/hpf (aga-jtf 2020 diagnostic threshold).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
fluticasone_propionate_swallowed	Adults: 880-1760 mcg/day (440 mcg BID — TID swallowed from MDI without spacer); rinse mouth; no food/drink for 30 min	oral_swallowed_topical	BID	AGA-JTF 2020 — strong recommendation for topical corticosteroid; swallowed fluticasone first studied; histologic remission ~50-65%
budesonide_oral_viscous	Adults: 1-2 mg PO BID swallowed (mixed with sucralose to viscous slurry; FDA-approved orodispersible 1 mg BID in EU); rinse mouth	oral_swallowed_viscous	BID	AGA-JTF 2020 — equally first-line topical steroid; budesonide oral suspension EoHilia FDA-approved 2024
omeprazole	20-40 mg PO BID × 8-12 weeks	PO	BID	AGA-JTF 2020 — PPI now accepted first-line therapy; ~30-50% histologic remission; AGREE consensus updated (PPI-REE no longer separate)
esomeprazole_magnesium	20-40 mg PO BID × 8-12 weeks	PO	BID	AGA-JTF 2020 — equally acceptable PPI option
six_food_elimination_diet	Empiric elimination of cow milk, wheat, egg, soy, nuts, seafood × 6 weeks then sequential reintroduction with biopsy	dietary	continuous	AGA-JTF 2020 — six-food elimination ~70% histologic remission; step-down to 1-food (milk-only) reasonable per recent evidence (Kliewer Gastro 2023)
one_food_elimination_milk_only	Cow milk elimination × 6 weeks then biopsy	dietary	continuous	Step-up dietary strategy; one-food (milk) remission ~40-50%, escalate if non-responder

Plan: EoE three-pillar therapy: topical steroid, PPI, dietary elimination + dupilumab for refractory (AGA-JTF 2020 + LIBERTY-EoE TREET 2022)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — In remission — continue maintenance

If you have:

No dysphagia or impactions
Eating diverse diet (within identified triggers)
Recent EGD with histologic remission (<15 eos/hpf)

Do this:

Take maintenance therapy as prescribed (do not skip swallowed steroid or PPI)
Continue identified food trigger avoidance if dietary pathway
Keep follow-up EGD appointments
Rinse mouth after swallowed steroid

YELLOW — Caution — symptoms returning, contact team

If you have:

Increased solid-food dysphagia
Need to chew thoroughly / take small bites
Sticking sensation but no impaction
Reflux returning

Do this:

Continue current therapy
Avoid hard / dry / sticky foods (bread, rice, meat)
Chew thoroughly; small bites; sip water with meals
Contact GI within 1-2 weeks for assessment
Possible repeat EGD + dose escalation

Call your provider if:

Symptoms worsening over days-weeks
New trigger foods identified
Need to adjust therapy

RED — Medical alert — food impaction, go to ED now

If you have:

Food bolus stuck — cannot swallow saliva
Drooling, vomiting, severe chest pain
Persistent regurgitation > 30 min

Do this:

Go to ED immediately — do NOT push food down (perforation risk)
Bring medication list
Notify GI team after stabilization
Plan EGD with biopsies during impaction removal

Call your provider if:

Food impaction — ED now

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Acute food bolus impaction — unable to swallow / drooling / vomiting (AGA-JTF 2020)
Symptomatic severe stricture or narrow-caliber esophagus on EGD (AGA-JTF 2020)
Pediatric EoE with growth failure / inadequate intake / feeding aversion (AGA-JTF 2020)

5. Follow-up

Long-term maintenance (EoE is chronic with high relapse); periodic EGD to confirm sustained remission; reassess dilation for fibrostenotic disease; transition pediatric→adult (AGA-JTF 2020)

6. Sources

Guideline: AGA Institute and Joint Task Force on Allergy-Immunology Practice Parameters 2020 Clinical Guidelines for the Management of Eosinophilic Esophagitis (Hirano et al, Gastroenterology 2020) + LIBERTY-EoE TREET dupilumab phase 3 (Dellon NEJM 2022)