A few years ago, a client wrote to tell me that her teenage son had just been diagnosed with eosinophilic esophagitis and was wondering if there were any nutritional treatments for it.
Last autumn, a childhood friend emailed me telling me he had been diagnosed with the same condition.
And then few weeks ago, I learned that an out-of-town male relative had also been diagnosed with it.
What Is Eosinophilic Esophagitis?
In the early 1990s, doctors began describing a new condition called eosinophilic esophagitis (known as EoE) affecting the esophagus, the muscular tube that leads from the mouth to the stomach that is often called “the food pipe.” EoE is a chronic immune system disease in which eosinophils, a type of white blood cell, build up in the esophagus, causing inflammation and injury to the esophagus as a reaction primarily to foods but sometimes to airborne allergens or acid reflux.EoE is now considered a major cause of digestive illness.
Researchers once thought EoE was a part, or type, of gastroesophageal reflux disease (GERD), but they eventually determined that EoE and GERD are separate conditions.
Difficulty swallowing is the most common symptom, and EoE sufferers try to adapt to it. They often are the last to finish a meal, use large amounts of liquid to wash food down, and sometimes suffer through episodes of food obstruction and regurgitating swallowed saliva, fluids, or solids until the food has shifted and passed.
Signs and Symptoms
According to the Mayo Clinic, there are multiple symptoms of eosinophilic esophagitis.- Food impaction (when food gets stuck in the esophagus after swallowing)
- Dysphagia (difficulty swallowing)
- Pain in the center of the chest that doesn’t respond to antacids
- Regurgitation (when undigested food comes back up)
- Dysphagia (difficulty swallowing)
- Pain in the abdomen
- Food impaction (when food gets stuck in the esophagus after swallowing)
- Feeding difficulty in infants
- Eating difficulty in children
- Vomiting
- Poor growth, weight loss, and malnutrition
How Common Is EoE, and Why Is It Increasing?
EoE is estimated to affect 1 in 2,000 adults in the United States, according to a 2013 analysis. However, the authors wrote that this number may underestimate the true prevalence of the condition, because both the knowledge of the new hospitalization diagnosis code and the recognition of EoE are still increasing.Greater awareness of the disease and more widespread use of endoscopy—a flexible tube with a light and camera attached to it, typically used to help diagnose EoE—may play a role in the rise in cases. But research points to a true increase in the incidence of the disease.
Nutritional Treatment for the Condition
It’s important to diagnose and treat esophagitis. If it isn’t properly diagnosed and treated, EoE may lead to the narrowing of the esophagus over time, and people who have EoE have an increased risk of multiple autoimmune diseases. Treatment options for the condition include swallowed steroids, proton pump inhibitors, periodic esophageal dilations, and food elimination diets.The Step-Down 6-Food Elimination Diet
The step-down 6-food elimination diet eliminates the six foods most commonly associated with the immune reaction that leads to EoE. The six foods are wheat, milk, soy, eggs, nuts, and seafood/shellfish. EoE symptoms are checked along with biopsy (removing samples of tissue during endoscopy) after six weeks, then each food is slowly reintroduced every two weeks while symptoms are monitored and recorded.The Step-Up 2-4-6 Elimination Diet
Another elimination diet variation, the step-up 2-4-6, is growing in popularity.- It starts with a 2-food group elimination diet, which eliminates all milk products and all gluten grains (not only wheat, but also rye, barley, oats, triticale, farro, einkorn, spelt, and kamut).
- If patients don’t achieve symptom improvement on the 2-food group elimination diet, they can “step up” to a 4-food group elimination diet, eliminating milk and gluten grains, plus egg and soy/legumes.
- If that doesn’t resolve their symptoms, they can “step up” again to a 6-food-group elimination diet, which includes eliminating milk, gluten grains, egg, and soy/legumes, plus nuts and fish/seafood.
How to Try an Elimination Diet for EoE
Successfully following an elimination diet involves a few important steps and adapting the diet in practical terms to your lifestyle. Also, keep in mind that foods that trigger EoE are highly individual. For those reasons, it’s important to work with a nutritionist or practitioner who specializes in elimination diets for EoE so he or she can help tailor the most appropriate food elimination diet for you and guide you through the process.When done successfully, completing a trial period of an elimination diet and then challenging yourself with each of the common EoE-triggering foods should not only resolve or alleviate discomfort in your esophagus, but also help you learn which foods are triggering the immune reaction and inflammation in your esophagus, so you can develop your own personalized therapeutic diet to prevent EoE and promote long-term esophageal health.