Eosinophilic Esophagitis: What to Do if Proton Pump Inhibitors (PPIs) Aren’t Helping
Health ConditionsDigestive Health

Eosinophilic Esophagitis: What to Do if Proton Pump Inhibitors (PPIs) Aren't Helping

Eosinophilic Esophagitis: What to Do if Proton Pump Inhibitors (PPIs) Aren't Helping
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Published on November 21, 2025
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Eosinophilic esophagitis (EoE), a chronic disorder that causes inflammation in the esophagus, is often treated first with drugs called proton pump inhibitors (PPIs).

 “In EoE, PPIs are used for anti-inflammatory properties rather than acid suppression,” says Alex Koral, MD, a gastroenterologist and an associate professor of pediatric gastroenterology at Yale School of Medicine in New Haven, Connecticut.
For inflammatory types of EoE, proton pump inhibitors may keep symptoms at bay long-term.

 But PPIs don’t work for everyone with eosinophilic esophagitis, and some people can’t take them because of interactions with other medications or if they have another condition that makes PPIs unsafe, says Dr. Koral.

PPIs may also fail to improve symptoms because of inconsistent dosing, genetic differences in medication processing, or other allergic conditions that make inflammation harder to control, says Hector Gonzalez, MD, a gastroenterologist with Gastro Health in Plantation, Florida.

The good news is there are many different ways to manage EoE symptoms, including dietary-based therapies that involve identifying and eliminating food triggers. For a medication approach, you and your doctor have several other choices.

Topical Steroids and Corticosteroids for Eosinophilic Esophagitis

If PPIs don’t improve your EoE symptoms, or there’s still evidence of EoE on your endoscopy (which can happen even if you don’t have symptoms), your doctor may suggest corticosteroids, which can improve inflammation.

 These are usually given in a liquid form that coats the lining of your esophagus. Options include:

“I typically recommend swallowed topical steroids for patients who don’t respond to PPIs or who have moderate to severe inflammation on biopsy,” says Ritu Nahar, MD, a gastroenterologist with Allied Digestive Health in New Brunswick, New Jersey. “These medications help calm the immune response directly in the esophagus.”

“These medications are often recommended for people who still have symptoms or inflammation despite trying PPIs or dietary changes,” says Dr. Gonzalez. “Studies show that swallowed steroids can significantly reduce inflammation and help many patients reach remission.”

In severe cases, your provider may recommend oral, injected, or intravenous steroids like prednisone that affect the whole body (systemic).

 “Because of potential side effects, these are used carefully — especially in children — and only for short periods when necessary,” says Gonzalez. Systemic steroids can cause side effects like skin changes, leg swelling, weight gain, depression, and high blood pressure.

But oral topical steroids like budesonide have a good safety record, with the most common side effect being a mild yeast infection in the mouth or esophagus, says Gonzalez.

Monoclonal Antibodies (Biologics) for Eosinophilic Esophagitis

Monoclonal antibodies (a type of biologic therapy) also target inflammation in the esophagus and can improve EoE symptoms like difficulty swallowing. “Biologics target specific inflammatory pathways driving EoE, offering a more tailored and systemic approach when traditional options aren’t enough,” says Dr. Nahar.
The only biologic therapy approved by the U.S. Food and Drug Administration to treat EoE is dupilumab (Dupixent), which is given by injection, although others are being tested. “Clinical studies show that dupilumab can improve swallowing, reduce inflammation, and even help heal narrowing in the esophagus after just a few months of treatment,” says Gonzalez.

Because it works in a targeted way, dupilumab has proved to be safe and well-tolerated, says Gonzalez. “The most common side effects are mild injection-site reactions, such as redness or tenderness.”

Some studies suggest providers try localized treatment options before offering dupilumab, which affects the whole body. But if you have EoE alongside other inflammatory conditions like asthma or atopic dermatitis, you may be started on this therapy first, since it can also treat these at the same time.

When to See Your Doctor

If you have eosinophilic esophagitis, see a gastroenterologist at least once a year or more for new or worsening symptoms.

 Gonzalez recommends contacting your healthcare provider if you experience:
  • Difficulty swallowing (dysphagia)
  • Food getting stuck in your esophagus
  • Chest pain
  • Unexplained weight loss

“These may be signs that the current treatment isn’t controlling the disease, and ignoring these symptoms can allow inflammation to progress and lead to complications such as food impaction, narrowing (strictures), or even poor nutrition,” says Gonzalez.

Nahar emphasizes the importance of regular visits with a provider. “Even if symptoms improve, regular follow-up and endoscopy are important, since inflammation can persist silently and lead to scarring or strictures over time.”

The Takeaway

  • Eosinophilic esophagitis is often treated with proton pump inhibitors, which block acid and lessen inflammation, but they don’t always work.
  • If PPIs don’t improve your symptoms, your provider may recommend swallowed steroids or a monoclonal antibody to target inflammation more directly.
  • Notify your healthcare provider if your symptoms get worse or don’t improve, and keep up with your regular checkups, even if you feel great.

Resources We Trust

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
  1. Feo-Ortega S et al. Evidence-Based Treatments for Eosinophilic Esophagitis: Insights for the Clinician. Therapeutic Advances in Gastroenterology. January 19, 2022.
  2. Eosinophilic Esophagitis (EoE). American Academy of Allergy, Asthma & Immunology. 2025.
  3. Schoepfer AM et al. Pharmacologic Treatment of Eosinophilic Esophagitis: Efficacious, Likely Efficacious, and Failed Drugs. Inflammatory Intestinal Diseases. 2024.
  4. Eosinophilic Esophagitis (EoE). American Partnership for Eosinophilic Disorders.
  5. Yasir M et al. Corticosteroid Adverse Effects. StatPearls. July 3, 2023.
  6. Eosinophilic Esophagitis. Cleveland Clinic. May 29, 2024.
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Yuying Luo, MD

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Yuying Luo, MD, is an assistant professor of medicine at Mount Sinai West and Morningside in New York City. She aims to deliver evidence-based, patient-centered, and holistic care for her patients.

Her clinical and research focus includes patients with disorders of gut-brain interaction such as irritable bowel syndrome and functional dyspepsia; patients with lower gastrointestinal motility (constipation) disorders and defecatory and anorectal disorders (such as dyssynergic defecation); and women’s gastrointestinal health.

She graduated from Harvard with a bachelor's degree in molecular and cellular biology and received her MD from the NYU Grossman School of Medicine. She completed her residency in internal medicine at the Icahn School of Medicine at Mount Sinai, where she was also chief resident. She completed her gastroenterology fellowship at Mount Sinai Hospital and was also chief fellow.

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