Eosinophilic esophagitis (EoE) is a chronic inflammatory condition affecting the esophagus—the tube connecting your mouth to your stomach. While proton pump inhibitors (PPIs) are often the first line of treatment, they don’t work for everyone. This article breaks down what happens when PPIs aren’t enough, and what alternative approaches exist.
Why PPIs Sometimes Don’t Cut It
PPIs are typically prescribed for EoE not to reduce stomach acid, but for their anti-inflammatory properties. However, several factors can limit their effectiveness.
Inconsistent use, genetic differences in how the body processes medication, or underlying allergic conditions can make inflammation harder to control. Some people may also be unable to take PPIs due to interactions with other medications or pre-existing health conditions. If you don’t respond to PPIs, or have inflammation confirmed by an endoscopy despite taking them, other options are available.
Next Steps: Steroids and Beyond
If PPIs fail, doctors often turn to topical steroids – liquid forms designed to coat the esophagus directly. Common options include budesonide (Eohilia), fluticasone (Flonase, Flovent), and ciclesonide (Alvesco).
These medications calm the immune response in the esophagus. Studies show they significantly reduce inflammation and can induce remission in many patients. In severe cases, systemic steroids (oral, injected, or intravenous) might be used, but these carry risks like weight gain, mood changes, and high blood pressure, so they’re reserved for short-term use, particularly in children.
Oral topical steroids like budesonide generally have a good safety profile, with the most common side effect being a mild yeast infection in the esophagus.
When to Seek Medical Attention
Don’t ignore worsening symptoms. Contact your gastroenterologist if you experience:
- Difficulty swallowing (dysphagia)
- Food getting stuck
- Chest pain
- Unexplained weight loss
These could indicate the disease isn’t under control, leading to complications like narrowing of the esophagus or poor nutrition. Even if symptoms improve, regular follow-up endoscopies are essential because inflammation can persist silently, causing scarring over time.
The Bottom Line
If PPIs aren’t working for your EoE, swallowed steroids or other targeted therapies may be necessary. Staying in regular communication with your healthcare provider and attending follow-up appointments is crucial for long-term management. Ignoring symptoms can allow inflammation to progress and lead to serious complications.
