The new guidelines lines from apfed and other egids (eosinophilic Gastro intestinal disease)
Use of a high dose protein pump inhibitor(ppi) has been effective in some at lower true EoE or E.G. -borderline EoE around 15 EOS per high power field
When the Eos (eosinophils) are low in number
Most GI recommend high dose ppi for 6-8 weeks and Rescope
For kids the options after ruling out the ppi isn't effective
Are six food allergen elimination diet (basically top eight food allergens
Milk wheat soy peanuts/treenuts eggs fish/shellfish)
If that doesn't work patch skin testing and Ige testing
Most children that don't clear on top eight diet
Use elemental formula only and introduce 1-3 foods for 8-12 weeks and rescope
Until a significant diet is established
Other option is swallowed Flovent /slurry
(Flovent is typically inhaled for asthma ) in EoE its swallowed to coat the esophagus
This can be done without any diet changes and after 8-12 weeks rescope to determine effectiveness
If the top 8 allergen diet or swallowed flovent is not effective some kids do both
To avoid elemental formula
Most adults start with swallowed Flovent since adults typically have a harder time adjusting their diet
EoE can cause thickening and furrowing of the esophagus
E.G. Is lower in the stomach and EC is near the rectum
They are a mixed Ige disorder
Helpful links
http://apfed.org/resources/for-patients/for-adults/
EoE is defined as an immune-mediated clinicopathologic condition characterized by esophageal dysfunction and eosinophil-predominant inflammation. This new conceptual definition has been proposed partly due to a recently identified disease phenotype called “PPI-responsive esophageal eosinophilia”. Emerging data support the possibility that this condition represents a clinical response to anti-inflammatory properties of PPIs that are independent of effects on gastric acid.
From
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4118554/
https://gi.org/guideline/evidenced-...osinophilia-and-eosinophilic-esophagitis-eoe/
https://www.jscimedcentral.com/Pedi...pediatric-gastroenterology-disorders-1040.pdf
A group to talk to other moms of kids with egids and adults who have the disease
https://community.kidswithfoodallergies.org/forum/gastrointestinal-disorders
More links
https://community.kidswithfoodaller...esources-egid-celiac-crohn-s-fpies-and-gerd-1
Hope that helps