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Eosinophilic Esophagitis: Which Rx When and for How Long?

Eosinophilic Esophagitis: Which Rx When and for How Long?

A 25-year-old man presents to the clinic with progressive dysphagia to solids. He says that his symptoms began approximately one year ago. Initially, he would experience difficulty swallowing about once per month, but the frequency has increased to twice weekly. He avoids certain foods for fear they will lodge in his esophagus—particularly breads and meats. He has no problems swallowing liquids. He had eczema as a child and his only current medical problem is seasonal allergies, for which he takes an over-the-counter antihistamine. He undergoes an upper endoscopy which demonstrates concentric rings and white plaques throughout the esophagus (Figure). Biopsies are taken from the mid- and distal esophagus. His peak eosinophil count is >100 eos/hpf.

How should you initially manage this patient?

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