Eosinophilic Oesophagitis 

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is caused by infiltration of eosinophils (white blood cells) into the lining of the oesophagus, causing symptoms such as chest pain, heartburn or painful swallowing and food getting stuck in the throat.

Eosinophilic Oesophagitis (EoE) can be caused by allergies to food or the environment. In 70% of cases, the symptoms can resolve or at least diminish if the responsible food allergy can be identified. 

Dietary management of EoE

• Dietary manipulation may assist, but should be undertaken under the direction of a gastroenterologist or immunologist, and supervised by a gastrointestinal dietitian.

• When undertaking dietary manipulation, foods are removed for a period of time and then re-introduced one at a time to see which foods result in symptoms.

• To find out what foods are responsible for causing these symptoms, it is necessary to eliminate these foods from the diet for 8-12 weeks.

• Elimination diets may include (6 food allergen elimination diet, 4 food allergen elimination diet & Step-up diet).

Six Food Elimination Diet (SFED)

These usually include the removal of cow’s milk, wheat, egg, soy, seafood (fish+ shellfish), and nuts (tree nuts+peanuts). Literature shows that this results in 72% endoscopic remission. This is followed by structured re-introduction and endoscopic assessment.
 

Four Food Elimination Diet (FFED)

These usually include the removal of cow’s milk, wheat, egg, soy. This can result in 50% remissions, most patients having one food trigger. It is a less restrictive option and only eliminating the 4 most common allergen. This is followed by structured re-introduction and endoscopic assessment.

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Step-up diets (1-2-4-6) 

Instead of removing many foods at the same time, one to two foods are removed at first, to see if symptoms improve, repeating a biopsy if they do, but removing more foods later on if inflammation persist on biopsy. Elimination of the most common food triggers (milk and wheat) and increase level of restriction for non-responders.

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1. ASCIA. (2019). Eosinophilic Oesophagitis. Retrieved from https://www.allergy.org.au/patients/food-other-adverse-reactions/eosinophilic-oesophagitis

2. Visaggi P, Mariani L, Pardi V, Rosi EM, Pugno C, Bellini M, Zingone F, Ghisa M, Marabotto E, Giannini EG, Savarino V, Marchi S, Savarino EV, de Bortoli N. Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach. Nutrients. 2021; 13(5):1630. https://doi.org/10.3390/nu13051630

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