Budesonide oral suspension is set to be the first FDA approved treatment for eosninophilic esophagitis. Takeda pharmaceuticals is the manufacturer of the drug. Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, inflammatory disease localized in the esophagus. The prevalence of EoE is rising. Approximately 1 in 2000 people
in the US live with EoE. EoE is a leading cause of dysphagia and food impaction for children and young adults.
We have extensively discussed eosinophilic esophagitis before and the treatment options available. Most allergists and GI doctors who treat EoE have been using steroid asthma inhalers in patients, instead of inhaling them, we ask patients to swallow it to coat the esophagus. Another alternative has been getting budesonide nebulized solution and mixing with a viscous base such as sugar and the patient will swallow it after. This can be somewhat cumbersome for patients, so a cleaner and easier to use alternative of using a prescription of budesonide oral suspension specifically for EoE will be much better.
Past studies of budesonide oral suspension can be read here:
Behaviors of patients who have EoE are chewing food excessively, eating slowly or cutting food into small pieces.
Other common adaptive behaviors are:
- Avoidance of large meals
- Avoidance of foods that have hard or lumpy textures
- Poor acceptance of new foods
- Lubricating food bites with condiments
- Drinking with most bites of food
- Substituting solids with blended or pureed foods
- Avoiding social settings involving food
Patients frequently present with atopic comorbidities that can lead to delayed diagnosis of EoE. In one study, ~78% of patients had ≥1 atopic disease. A family or personal history of pre-existing allergic diseases should increase the suspicion for EoE and should be considered. Consider investigating EoE further with endoscopies and biopsies when patients present with symptoms of esophageal dysfunction along with any of the following:
- Allergic rhinitis
- Atopic dermatitis
- Food allergy
We have extensively discussed EoE in past blogs, the diagnosis, management and treatment options (present and future) are all below.
For now we are excited about the first FDA approved treatment option of EoE, budesonide oral suspension. The cost and brand name have not been released yet, but its approval by the FDA is eminent. Check back with us later.