Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus (the “food pipe” that goes from the mouth to the stomach). It is typically triggered by allergies to certain foods or environmental substances (such as pollen, weeds, or trees), resulting in redness, swelling, and damage to the esophagus. Adults with EoE commonly complain of difficulty swallowing (dysphagia), feeling food move slowly down the food pipe, or food getting stuck in their food pipe (food impaction).
EoE is diagnosed by endoscopy (a procedure used to visualize the food pipe and stomach using a tiny camera). Several small tissue samples (called a biopsy) of the food pipe are taken during the procedure and sent to the laboratory for analysis under a high-power microscope. EoE is confirmed when high numbers of harmful cells (called eosinophils) can be seen on these samples under the microscope.
How are the triggers identified and treated?
Once the disease is confirmed by endoscopy, the next steps are to identify the potential triggers and implement an appropriate treatment plan designed to eliminate the harmful cells. Triggers are commonly identified using a prescribed process of dietary food elimination and food reintroduction. While this type of dietary treatment helps most people, sometimes the addition of medications, such as proton pump inhibitors or corticosteroids, may be needed if symptoms persist or worsen.
People with EoE know the ongoing challenges associated with accurately identifying the triggers of their disease.
Dietary treatment using food elimination and food reintroduction is often the first approach used to identify triggers and treat EoE. In most cases, one or more of the following food groups may be identified as triggers for EoE.
What are the dietary treatment approaches to determine EoE triggers?1
A systematic dietary treatment involving food elimination and food reintroduction is usually required to identify the foods that may be triggering your EoE. The goals of dietary treatment are illustrated below.
If food elimination therapy is effective, your body should stop producing the harmful cells in your food pipe, swelling of your food pipe should get better, and your ability to swallow foods should improve.
Your doctor and healthcare team (nutritionist/dietician, nurse) will teach you how to carry out a dietary treatment plan, and continuously monitor your symptoms and response to treatment. The two most common food elimination diets are:
Be sure to talk to your doctor about which food elimination dietary treatment may be best for you. Research studies have shown that both food elimination diets are able to reduce the number of harmful cells in your food pipe.
Food elimination dietary treatment– steps to identify and remove food triggers
Once a food group is identified as the trigger food, you will be directed to remove the allergy-causing food from your diet.
Elemental Diet Treatment – steps to identify and remove food triggers
Your doctor may recommend that you be treated with a special liquid diet called an elemental diet. With the exception of Step 2 below, the steps for this diet are similar to the food elimination diet.
Not all insurance companies provide coverage for an elemental diet. Before beginning this dietary treatment, discuss the cost with your doctor, and ask whether your insurance will cover the treatment.
Allergy testing to identify the food trigger
Your doctor may recommend that you be evaluated by an allergy specialist (allergist) to help identify your allergy triggers. If food allergies are determined, your doctor will direct you to follow a food elimination diet, specific to your allergen.
You can learn more about EoE allergy testing on the healtheo360 blog.
I can swallow better, so why do I need to have repeat endoscopies?
Although dietary treatment will usually improve the ability to swallow foods more comfortably, harmful cells may still be present in your food pipe. Therefore, to accurately assess your response to dietary treatment, your doctor must perform repeat endoscopies.
- Response to treatment is determined by:
- Improvement of symptoms
- The reduction of eosinophils, as seen under the microscope
If eosinophils remain present, your disease is active (even though your symptoms may have improved).
- Gonzalez-Cervera, et al. J Investig Allergol Clin Immunol 2016; 26(1): 8–18
Copyright ©2017 Link Health Group LLC. All rights reserved. Authored by Susan Jenny BScN (2017)