Practical approach to implementing dietary therapy in adults with eosinophilic esophagitis: the Chicago experience

Abstract

Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated esophageal disease characterized by esophageal dysfunction and esophageal mucosal eosinophilia. Diet therapy is effective in the treatment of EoE in both children and adults. The role of food allergens is well established in the pathogenesis and treatment of eosinophilic esophagitis. Empiric elimination with a six-food elimination diet (avoiding milk, wheat, egg, soy, peanuts/tree nuts, and fish/shellfish) demonstrates remission in over 70% of adults with this disease. Dietary therapy in adult EoE is becoming more accepted by both patients and clinicians. Dietary therapy can be effectively implemented in clinical practice with appropriate dietary education, patient resources, and close communication with physician and clinical staff. The ability to identify specific food triggers to help tailor dietary therapy for long-term management allows for a return to consumption of most table foods. Furthermore, the diet approach avoids the need for chronic topical corticosteroid use and possible long-term side effects of these medications. The decision to proceed with dietary therapy should be decided by patient preference and available resources. A collaborative and multidisciplinary approach including gastroenterologists, allergists, nurses, and dietitians is essential in the success of this approach.

Elimination and elemental diet therapy in eosinophilic oesophagitis

“…The success of SFED depends on a strict elimination of the six foods, since little allergens may be enough to provoke the inflammation [28]. On the other hand, threshold levels for allergens may be higher due to the non-IgE mediated mechanisms.…”

“…Despite all the reports confirming the influence of the major food allergens, it should be noted that more than 170 different foods have been associated with allergic reactions [28]. Advantages of SFED are that it does not require allergy testing and it allows the consumption of multiple table foods.…”

Eosinophilic Esophagitis–More than Two Decades of Progress

“…Food re-introduction can be done in a stepwise fashion. Repeat endoscopies are required when the food groups are reintroduced after 4-6 weeks to determine esophageal eosinophil count [80]. The most common foods associated with EoE based on re-introduction were wheat (60% of cases) and milk (50% of cases) [76].…”

Acute exacerbation of dysphagia due to foreign body impaction in an oesophageal stricture due to eosinophilic esophagitis

“…Proton pump inhibitors are beneficial in a subgroup of patients,4 although the original description of EoE excluded proton pump inhibitor responsive disease 5. Dietary exclusion therapy, which was used initially in infants, has been found recently also to be feasible and effective in adult patients 6. Endoscopic dilation is a recognised treatment in stenosing EoE 7.…”