American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medication is used for the medical therapy of eosinophilic esophagitis?

1. Swallowed aerosolized topical glucocorticoids

2. Oral antihistamines

3. Systemic steroids

4. Proton pump inhibitors

The correct answer is: Swallowed aerosolized topical glucocorticoids

The use of swallowed aerosolized topical glucocorticoids is well-established in the medical management of eosinophilic esophagitis (EoE). This condition is characterized by an inflammatory response within the esophagus, often in response to food allergens, leading to symptoms such as difficulty swallowing and food impaction. Topical glucocorticoids, when swallowed, act locally in the esophagus to reduce inflammation and eosinophilic infiltration without the systemic side effects associated with prolonged systemic steroid use. The goal of treatment is to alleviate symptoms and heal the esophageal lining, making this approach effective and safe. Other options, while they may have roles in the management of different gastrointestinal conditions, are not specifically indicated as primary treatments for eosinophilic esophagitis. Oral antihistamines, for example, are generally used for conditions related to allergic responses but do not effectively address the specific inflammatory processes involved in EoE. Systemic steroids are not the frontline therapy due to their potential side effects and lack of targeted action in the esophagus. Proton pump inhibitors can be beneficial in treating acid reflux but do not directly resolve the eosinophilic inflammation characteristic of this condition. In summary, swallowed aerosolized topical glucoc