SWALLOWING DIFFICULTIES:
EOSINOPHILIC OESOPHAGITIS?
INFORMATION FOR PEOPLE WITH THE CONDITION
Diets for the treatment of eosinophilic oesophagitis
In most EoE patients, there are often several foods that trigger allergic reactions in the oesophagus. EoE is therefore a special form of food allergy. If these specific foods can be identified and completely removed from the diet, the symptoms and inflammation can be reduced without the use of medication. The most common causes of eosinophilic inflammation in the oesophagus are milk and dairy products, wheat and other cereals containing gluten, soy/legumes, eggs, nuts and fish/seafood. A diet of this kind is usually associated with massive dietary restrictions.
Empirical elimination diet
How effective is an elimination diet?
In the empirical (experience-based) elimination diet, the six most common EoE-causing food categories are removed from the diet and then gradually reintroduced until the responsible triggers are identified. Its efficacy has been demonstrated in children and adults. Consistent implementation of this diet reduces inflammation in the oesophagus in over 70 % of patients.
How does an elimination diet work?
In theory, milk and dairy products, wheat and other gluten-containing grains, soy/legumes, eggs, nuts and fish/seafood are completely removed from the diet for six to eight weeks. An endoscopy of the oesophagus is then carried out, during which tissue samples are also taken. Ideally, the inflammatory cells in the oesophagus will have disappeared completely at this point. Afterwards, the individual food categories are reintroduced into the diet one after the other at eight-week intervals. Approximately eight weeks after the resumption of a category, another endoscopy of the oesophagus is performed. This makes it possible to determine whether the reintroduced category is (partly) responsible for the oesophageal inflammation. This evaluation continues until all categories have been tested. As soon as all allergenic foods have been identified, patients must then consistently and permanently remove them from their diet. However, this procedure is not followed in practice, as up to eight endoscopies within a year involve a great deal of effort for both patients and doctors, which means that the regimen is only carried out reluctantly.
In order to reduce the patient’s oesophageal symptoms, a so-called step-up approach is sometimes used, whereby only two food categories (usually milk and dairy products and wheat and all gluten-containing cereal products) are initially removed from the diet. Only in the event of non-response, four and finally all six categories are eliminated from the diet. This allows the number of endoscopies of the oesophagus to be reduced by an average of 20 %.
What are the limitations of an elimination diet?
It may take about one year for the trigger food category/categories to be identified, which means it is of little practical relevance. In some cases, up to eight oesophageal endoscopies may be necessary to identify the allergens that trigger the disease. In addition, it takes time to provide comprehensive dietary advice and any allergenic foods identified must be strictly and permanently eliminated. This can be associated with significant limitations to quality of life.
Allergy test-based diet
Only a small number of patients are able to identify the responsible food components using an allergy test-based elimination diet, which means it is only effective in a small proportion of patients.
Amino acid-based formula (elemental diet)
How effective is a diet with amino acid-based formula?
On this diet, all conventional foods must be avoided and a special formula must be taken instead. This industrially produced liquid food contains no allergenic proteins and consists only of the basic building blocks of food proteins, known as amino acids, and other nutrients. A protein-free diet of this kind has resulted in a reduction in the inflammatory response in over 90 % of adult EoE patients.
How should amino acid-based formula be taken?
Adults can follow this diet at home if they are able to drink the formula, which many people feel tastes extremely unpleasant. Children and adolescents who need to be treated with this diet usually cannot bear the taste, which means that the formula needs to be administered via a gastric tube during an inpatient hospital stay.
What are the limitations of a diet with amino acid-based nutrient formula?
Most patients find the diet with amino acid-based formula extremely difficult for the reasons mentioned above. This means that a diet of this kind is associated with a significant loss of quality of life and is hardly feasible in the long term.
