Foods, Warning Signs and Treatment Options
Eosinophilic esophagitis (EoE) is a relatively common chronic immune system disease that leaves affected individuals with inflammation within the tube running from the mouth to the stomach. An excess of white blood cells lining the esophagus causes painful inflammation. Let's dive into EoE.
6 Triggers for Eosinophilic esophagitis
Research has shown that allergies to certain foods may worsen the symptoms of EoE, and many health experts suggest that eliminating six essential foods can improve symptoms:
- Milk.
- Egg.
- Wheat.
- Soy.
- Fish.
- Nuts.
Excluding certain foods from the diet has been a cornerstone of EoE treatment. During the early 2000s, researchers found that eliminating six common food triggers of esophageal injury—milk, egg, wheat, soy, fish and nuts—substantially reduced signs and symptoms of EoE. This six-food elimination diet (6FED) became a common approach to managing the disease.
This inflammation in the esophagus results in swallowed food moving slowly through the esophagus; those with this disease report that swallowing can be uncomfortable, painful and quite distressing. EoE is an incredibly complex disease that impacts daily life; finding a healthcare professional with extensive knowledge of this disease is critical.
Foods and Drinks to Avoid for EoE
- Dairy products (milk, cheese, yogurt).
- Eggs.
- Wheat.
- Soy (including soy milk).
- Peanuts.
- Tree nuts (almonds, walnuts, etc.).
- Fish.
- Shellfish.
- Beer.
- Wine.
Dietary Considerations
As mentioned above, those with EoE may need to eliminate milk, egg, wheat, soy, fish and nuts from their diet to reduce their symptoms. While eliminating all six of these food items is a common approach, some opt to stop eating one food group at a time to determine if others can be tolerated. As malnutrition is a concern in an elimination diet, consider consulting a Registered Dietician or Registered Nutritionist to ensure all dietary needs are met.
When those with EoE eat food they cannot tolerate, it does not produce an allergic reaction such as hives, vomiting or difficulty breathing. Instead, it may take a few days for the immune system to react and cause the symptoms of EoE. Continuous eating of allergens leads to chronic and worsening symptoms.
As some find the elimination diet restrictive, eliminating certain foods one at a time may be an option. However, by removing all food allergen sources from the diet, relief from symptoms may be obtained more quickly. Once the signs and symptoms of EoE are under control, eliminated foods may be slowly introduced one at a time to determine if they can be tolerated.
Other Factors that Worsen EoE
Environmental Allergies
Some of those with EoE find that seasonal allergies and allergies to pollen, dust mites and mold worsen their EoE signs and symptoms. Be sure to discuss testing for allergies such as these with your healthcare team. By determining allergens, relief from EoE is made manageable.
Atopic
Most individuals with EoE also live with other allergic disorders such as asthma, eczema and rhinitis. Atopic simply refers to having more than one allergic disorder; a flare in one allergic illness can increase the signs and symptoms of another disease.
Warning Signs
In EoE, there is an immune system reaction to certain foods. Warning signs to watch for are different in children than they are for adults. In children, you may notice fussy eating, lack of growth, symptoms of malnutrition, vomiting and reports of chest pain and sore tummies. One of the first signs you may observe in a child is difficulty swallowing and food refusal.
In adults, you may see the individual drinking more fluids, which aids in swallowing. Certain foods, such as heavy breads, may be avoided, particularly those that are already challenging to eat. Adults with EoE report that heartburn and chest pain are troublesome symptoms. Many also report that acid reflux is a painful symptom, made worse by choosing inappropriate dietary items such as dairy.
Also, you may notice that the person chews longer than usual, has trouble swallowing and may even experience a life-threatening food blockage that requires emergency medical attention.
Treatment Options For Eosinophilic Esophagitis
If someone with EoE has a food blockage and cannot speak or breathe adequately, call emergency services immediately, as this may be life-threatening.
In addition to dietary restrictions, several other treatment options exist for those with EoE. One such treatment is an injectable medication called Dupixent (dupilumab), which reduces inflammation, allowing for easier swallowing. Unfortunately, this drug is only approved for use with adults and requires a weekly injection.
Another medication commonly used to reduce symptoms of EoE is proton pump inhibitors (PPI). PPI acts to reduce stomach acid production and the esophageal inflammation associated with EoE. However, this treatment is not adequate for everyone, and other treatments may need to be combined with PPI to achieve relief.
Corticosteroids, taken by mouth, have also been found to reduce EoE inflammation and thus improve symptoms. Following regular treatment via corticosteroids, the dose may be decreased once symptoms have improved.
Allergy Testing is one method of determining which foods and environmental factors may aggravate EoE. By testing for allergens, those with EoE can be sure which foods must be avoided and if they need to avoid specific ecological settings, such as hayfields and gardens.
Dilation is a treatment that may increase the diameter of the esophagus; a larger circumference within the esophagus will allow for swallowed food to pass through more easily. While under sedation, a balloon-like tube is inserted into the esophagus and gently inflated to stretch the esophagus. One drawback of this treatment is that it does not reduce inflammation, so it is best used in concert with other therapies.
The Link Between EoE and Asthma
EoE and asthma are interconnected through their shared inflammatory pathways. Both conditions involve an overactive immune response where eosinophils, a type of white blood cell, play a key role.
In EoE, eosinophils accumulate in the esophagus, causing inflammation and damage. Similarly, asthma features eosinophilic inflammation in the airways, leading to symptoms like wheezing and breathlessness. Research suggests that individuals with EoE may have a higher risk of asthma, and managing one condition can sometimes improve symptoms of the other, highlighting the importance of a comprehensive approach to treatment.