American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of treatment is commonly used for eosinophilic esophagitis?

1. Oral steroids

2. Swallowed aerosolized glucocorticoids

3. Proton pump inhibitors

4. Dietary modifications

The correct answer is: Swallowed aerosolized glucocorticoids

Swallowed aerosolized glucocorticoids are a key treatment approach for eosinophilic esophagitis (EoE), a chronic inflammatory condition characterized by an eosinophilic infiltration of the esophagus. This treatment modality is specifically effective because it delivers anti-inflammatory medication directly to the esophagus, where the eosinophilic inflammation occurs. These glucocorticoids help decrease the inflammatory response in the esophageal tissue, reducing symptoms such as dysphagia (difficulty swallowing), food impaction, and chest pain. The localized action of these medications minimizes systemic side effects often associated with oral steroids while providing effective symptom relief. In contrast, while proton pump inhibitors are sometimes used in patients with EoE who may also have gastroesophageal reflux disease, they do not directly impact the eosinophilic component of the disease. Dietary modifications can be beneficial for managing specific triggers but are not considered a primary treatment. Oral steroids may be effective but are generally reserved for cases that do not respond to other therapies or in acute exacerbations due to their systemic effects. Thus, swallowed aerosolized glucocorticoids represent the most direct and effective treatment option for managing the underlying inflammation in eosinophilic esophagitis.