What is EoE?
EoE is caused by infiltration of eosinophils (white blood cells) into the lining of the oesophagus, an area which is normally free of eosinophils. This can cause symptoms such as chest pain, heartburn or painful swallowing, however the most common presenting symptoms are difficulty swallowing and food getting stuck in the throat. These symptoms are similar to reflux, howevernot relieved with reflux medications.
How is EOE diagnosed?
EOE is diagnosed by biopsy of the oesophagus via gastroscopy and it 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.
EoE may result from drug and food allergy
Around 75% of people with EoE have other allergic conditions such as allergic rhinitis or asthma.
Allergy testing is not considered to be a reliable indicator of response to dietary manipulation and is not recommended unless a person has evidence of rapid onset allergic symptoms after food consumption as well as EoE.
When food is the cause of EOE, cow's milk (dairy products), wheat and egg are the major triggers, with soy, seafood and nuts less commonly being involved.
If left untreated about 30-50% of individuals with EoE will eventually get food stuck in the oesophagus, which may have to be removed in hospital. It can result in permanent scarring and narrowing of the oesophagus (stricture).
Diet for EOE?
Dietary manipulation may assist, but should be undertaken under the direction of a gastroenterologist or immunologist, and supervised by a specialist dietitian.
When undertaking dietary manipulation, the 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.
Dietary manipulation for EoE:
6 food allergen elimination diets: 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.
4 food elimination diet: 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. Combine PPI + 4 food elimination – promising option.
Step-up diets (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. Eliminate the most common food triggers (milk and wheat) and increase the level of restriction for non-responders.
Ensure you see a specialist gastrointestinal dietitian for individualised advice to ensure you are supported through all stages of you EOE journey. For more information get in contact with us here at the @dietetic.gut.clinic