SWALLOWING DIFFICULTIES:
EOSINOPHILIC ESOPHAGITIS?
SWALLOWING DIFFICULTIES:
EOSINOPHILIC ESOPHAGITIS?
SWALLOWING
DIFFICULTIES:
EOSINOPHILIC
ESOPHAGITIS?
TREATMENT OF EOSINOPHILIC ESOPHAGITIS WITH DIETS
Most patients with eosinophilic esophagitis are allergic to more than one food, and EoE is therefore regarded as a special type of food allergy. If it is possible to eliminate all foods from your diet that cause an allergic reaction in the oesophagus, symptoms and inflammation can disappear without the need for medication. The most common foods that cause EoE are dairy products, wheat, eggs, soy, nuts, and fish/seafood. Eating the right kind of diet may therefore be associated with massive restrictions on your food choices and can be hard to stick to for a long period of time.
Eliminating foods that may cause EoE can improve symptoms.
AMINO ACID-BASED NUTRIENT SOLUTIONS
How effective are amino acid-based nutrient solutions in the treatment of EoE?
No conventional foods are eaten with this diet and a special nutrient solution is taken instead, i.e. this diet is free of any allergy-triggering proteins. It consists solely of amino acids, which are the basic building blocks of proteins, and some other nutrients. The amino acid solutions are industrially produced. Such protein-free diets have been found to be effective in reducing inflammation in over 90% of patients with EoE.
How do you take amino acid-based nutrient solutions?
Adult patients can manage this diet at home, provided that you are able to tolerate the taste, which is often described as unpleasant. Children/adolescents who need an amino acids-based diet usually do not tolerate the taste and the solution is administered via a feeding tube during an in-patient stay in hospital.
What are the side effects/limitations of an amino acid-based solution diet?
Most patients find this diet to be extremely restrictive because they are not permitted to eat anything else. Adult patients seldom choose this diet.
EMPIRICAL ELIMINATION DIET
How effective is an empirical elimination diet in the treatment of EoE?
An elimination diet based on allergy testing only results in an improvement of symptoms in a handful of patients. Allergy tests are generally not specific enough to identify EoE-causing allergens and rarely achieve their objective. An empirical elimination diet is therefore often the best choice. This starts with initially excluding the six food groups that most commonly cause an allergic reaction, followed by controlled step-by-step reintroduction of one food at a time until the ‘culprit’ has been identified. This six food elimination diet (6-FED) is proven to be effective in both children and adults. Inflammation of the oesophagus can be successfully reduced in over 70% of patients who are following this diet.
Procedure
How do elimination diets work?
An 6-FED diet involves the complete elimination of dairy products, wheat, eggs, soy, nuts, and fish/seafood from the diet for 6-8 weeks. Then, an endoscopy is performed and tissue samples (biopsies) are taken. In the best case scenario, the inflammatory cells have disappeared from the oesophagus. Each individual food group is then reintroduced one after the other at 8-week intervals. An endoscopy is performed about 8 weeks following reintroduction of each new food group to determine whether it has triggered eosinophilic inflammation in the oesophagus. This procedure is repeated until all foods that trigger a response have been identified. They then need to be excluded from the diet for good.
A dietitian will help you with suggestions and advice on how these foods can be avoided over a number of sessions. The diet takes place on an out-patient basis. As an alternative to the 6-FED, a so-called step-up elimination diet may be chosen in order to reduce the number of endoscopies needed. Here, only two food groups (usually dairy and wheat) are eliminated initially and if there is no improvement, a total of four, and, if necessary six food groups are excluded from the diet. The number of endoscopies can be reduced by about 20% with this approach. As with the 6-FED, any food group found to trigger an inflammatory response has to be permanently avoided.
What are the limitations of elimination diets?
It can take up to a year to identify the food(s) that cause a reaction and some patients need up to 8 endoscopic examinations to get a definite result. You also should attend multiple sessions with a dietitian when following the empirical elimination diet. You will not be able to consume the food groups identified for a very long time, which can reduce your quality of life.