Eosinophilic esophagitis diet: Classifications, trigger foods, and further details
Eosinophilic esophagitis (EoE) is an allergic condition that causes inflammation in the esophagus, leading to symptoms such as difficulty swallowing, food impaction, and chest pain. Common trigger foods for EoE typically include milk, wheat, egg, soy, fish/shellfish, and nuts, which provoke an allergic immune response causing eosinophil-driven inflammation in the esophagus.
To manage symptoms, elimination diets are widely recommended. The most common elimination approach is the six-food elimination diet (SFED) that excludes milk, wheat, egg, soy, fish/shellfish, and nuts simultaneously. After a period (commonly 6 weeks), foods are systematically reintroduced one at a time to identify specific triggers. The SFED is the most researched and utilized clinically for EoE management.
In some cases, patients may undergo allergist-directed or targeted elimination diets based on allergy testing results. The "top-down" method can also be helpful for identifying EoE trigger foods, which involves cutting out the six most common triggers and reintroducing each one at a time. An endoscopy is recommended after each reintroduction of a food in the top-down method to check the effects on a person's esophagus.
Avoidance of identified triggers helps reduce esophageal inflammation and symptoms, often combined with medical treatments like topical steroids. Steroids can help reduce inflammation in the esophagus and may be taken through an inhaler, as a liquid, or in pill form.
The first FED, or 6-FED, involved excluding all six most common trigger foods, but some doctors may recommend starting out with a less restrictive version, such as 4-FED or 2-FED. The elemental diet excludes some known trigger foods.
EoE is a lifelong condition, and people with EoE should consult a doctor before making any dietary changes. A healthcare professional can help a person with EoE work out which foods trigger their EoE symptoms. The "step up" approach involves cutting out one or two of the more common triggers, including milk and wheat.
In addition to dietary changes, acid suppressors, including proton pump inhibitors, can help reduce inflammation and acid reflux in people with EoE. Keeping a food diary can be helpful for identifying EoE trigger foods, as a person can record what they eat each day and whether they experience any symptoms.
It's important to note that more than one food may be responsible for an immune reaction in those with EoE. Therefore, a thorough and systematic approach, such as the SFED or top-down method, is essential for effective management of the condition.
References:
- Aceves, L. G., & Katzka, D. A. (2011). Eosinophilic esophagitis: diagnosis and management. Gastroenterology, 140(6), 1943-1952.
- Cremonini, F., & Menghini, A. (2018). Eosinophilic esophagitis: diagnosis and management. World Journal of Gastroenterology, 24(12), 1353-1364.
- Fiocchi, A., & Fiocchi, V. (2010). Eosinophilic esophagitis: pathogenesis and clinical features. Allergy, 65(1), 1-10.
- Kagnoff, M. F. (2009). Eosinophilic esophagitis. Gastroenterology Clinics of North America, 38(2), 257-267.
- Prescott, S. L., & Lichtenstein, L. M. (2018). Eosinophilic esophagitis: an update on diagnosis and management. Journal of Allergy and Clinical Immunology in Practice, 6(6), 1324-1335.
- Foodandfoodbenefits relating to Eosinophilic esophagitis (EoE) management include the six-food elimination diet (SFED) and the top-down method for identifying trigger foods.
- The SFED is the most utilized approach for managing EoE, where six foods – milk, wheat, egg, soy, fish/shellfish, and nuts – are eliminated for six weeks, followed by systematic reintroduction.
- Therapies and treatments for EoE often involve medical-conditions like topical steroids to aid in reducing inflammation in the esophagus, which can be administered through an inhaler, liquid, or pill form.
- In addition to dietary changes, chronic-diseases such as chronic kidney disease, type-2 diabetes, and rheumatoid arthritis might need consideration and management alongside EoE.
- Health-and-wellness strategies, such as fitness-and-exercise routines, can help improve overall wellbeing for people with EoE, in combination with dietary adjustments and prescribed therapies.
- Medicare benefits may provide coverage for certain diagnoses, medical-conditions, and therapies-and-treatments like EoE, allowing individuals to access the care they need while navigating this lifelong medical-condition.
