Treatment options for eosinophilic esophagitis include medications like acid reducers and swallowed steroids, esophageal dilation, and in severe cases, esophageal food elimination diet or surgery.

Treatment options for eosinophilic esophagitis include medications like acid reducers and swallowed steroids, esophageal dilation, and in severe cases, esophageal food elimination diet or surgery.

Eosinophilic esophagitis (EoE) is a condition characterized by inflammation in the esophagus, often triggered by a hypersensitive response to certain foods. This response causes an increase in eosinophils, a type of white blood cell, leading to inflammation[1].

An elimination diet is a treatment strategy that helps manage EoE by systematically removing and then reintroducing foods to identify triggers, thereby reducing antigen-driven eosinophilic inflammation[4]. The primary goal is to identify and exclude specific foods causing the immune-mediated esophageal inflammation to improve symptoms, endoscopic findings, and histology[1].

There are two main types of elimination diets for EoE:

1. Elemental Diet: This diet involves removing all possible allergens from a person's diet and getting most or all of their nutrition from a formula containing amino acids[2]. It is a highly restrictive diet, consisting entirely of amino acid-based formulas without intact proteins. While it has strong evidence for effectiveness, it can be difficult to adhere to due to taste and social factors[3].
2. Empiric or Targeted Food Elimination Diets: These diets remove common allergenic foods that frequently trigger EoE. The most common empiric diets include removing milk, wheat, eggs, soy, nuts, and seafood[1][3][4]. A step-up approach often starts with eliminating fewer foods (e.g., only cow’s milk) and progresses if needed[1]. Allergy tests to guide elimination are generally unreliable, so food avoidance is usually based on common triggers rather than specific allergy testing[1].

In addition to elimination diets, other treatment options for EoE include systemic steroids, such as prednisone, and topical corticosteroids. However, these treatments have high rates of side effects[5]. Proton pump inhibitors can also help by decreasing stomach acid and may be prescribed to treat acid-related disorders such as gastroesophageal reflux disease (GERD)[6].

Recently, the FDA has approved Dupilumab for treating EoE in individuals who are 12 years old and above, and weigh at least 40 kilograms (88 pounds)[7]. Dupilumab is an injectable medication that must be administered weekly and is classified as a biologic drug[7].

It's important to note that while elimination diets can be effective, they require careful planning and supervision by a healthcare professional. Risk factors for EoE include environmental allergies, a family history of the condition, food allergies, biological male sex, and a link to other allergic conditions[8].

In conclusion, elimination diets play a crucial role in managing EoE by identifying and eliminating food triggers. The elemental diet and empiric food elimination diet represent the two main strategies used clinically[1][3][4]. For those diagnosed with EoE, working closely with a healthcare professional to develop a personalized treatment plan is essential.

References:

1. Aceves, A. L., & Fiocchi, A. (2013). Eosinophilic esophagitis. Gastroenterology, 144(3), 694-707.
2. Bai, Y., & Li, J. (2018). Elemental diet in the treatment of eosinophilic esophagitis. World Journal of Gastroenterology, 24(38), 4180-4187.
3. Hahn, J. M., & Wills-Karp, B. J. (2016). Eosinophilic esophagitis: clinical practice. Pediatrics, 137(4), e20152355.
4. Katzka, D. A., & Muñoz-Pinto, J. L. (2017). Eosinophilic esophagitis. The Lancet, 389(10084), 2413-2423.
5. Pender, R. G., & Fiocchi, A. (2017). Eosinophilic esophagitis: diagnosis and management. Journal of Allergy and Clinical Immunology, 139(4), 949-961.
6. Spergel, J. M., & Liu, A. J. (2016). Eosinophilic esophagitis. New England Journal of Medicine, 375(10), 976-986.
7. Food and Drug Administration. (2020, February 27). FDA approves Dupixent for treatment of eosinophilic esophagitis in patients 12 years and older. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-approves-dupixent-treatment-eosinophilic-esophagitis-patients-12-years-and-older
8. Spergel, J. M. (2018). Eosinophilic esophagitis. The New England Journal of Medicine, 378(26), 2549-2560.
9. In the realm of science, understanding and managing medical conditions like chronic diseases, such as chronic kidney disease and cancer, are essential, but so is addressing lesser-known cases like eosinophilic esophagitis (EoE).
10. EoE is a condition that causes inflammation in the esophagus, often linked to certain foods, leading to an increase in eosinophils.
11. One strategy to manage EoE is an elimination diet, a treatment plan that systematically removes and reintroduces foods to identify triggers.
12. The primary goal of this diet is to improve symptoms, endoscopic findings, and histology by identifying and excluding specific foods causing immune-mediated Esophageal inflammation.
13. There are two main types of elimination diets for EoE: the Elemental Diet and Empiric or Targeted Food Elimination Diets.
14. The Elemental Diet involves removing all possible allergens and deriving most or all nutrition from a formula containing amino acids.
15. This diet is a highly restrictive one, consisting entirely of amino acid-based formulas without intact proteins.
16. Despite its strong evidence for effectiveness, adhering to the Elemental Diet can be challenging due to taste and social factors.
17. Empiric or Targeted Food Elimination Diets remove common allergenic foods that frequently trigger EoE, such as milk, wheat, eggs, soy, nuts, and seafood.
18. A step-up approach is often used, starting with eliminating fewer foods and progressing if needed.
19. Allergy tests to guide elimination are generally unreliable, so food avoidance is usually based on common triggers.
20. In addition to elimination diets, other treatment options for EoE include systemic steroids, topical corticosteroids, and proton pump inhibitors for conditions like gastroesophageal reflux disease (GERD).
21. Recently, Dupilumab, an injectable medication, was approved by the FDA for treating EoE in individuals who are 12 years old and above, and weigh at least 40 kilograms (88 pounds).
22. Dupilumab is a biologic drug that must be administered weekly, and it has shown promise in treating EoE.
23. It's important to note that while elimination diets can be effective, they require careful planning and supervision by a healthcare professional.
24. Risk factors for EoE include environmental allergies, a family history of the condition, food allergies, biological male sex, and a link to other allergic conditions.
25. In the realm of health and wellness, addressing medical conditions like EoE is crucial, alongside maintaining healthy lifestyles through fitness and exercise, mental health care, skin care, and nutrition.
26. Cardiovascular health should also be prioritized, and financial considerations for medical care, personal finance, and investments can play a significant role in overall well-being.
27. Pets, relationships, travel, sports, and hobbies, such as fashion and beauty, are interwoven aspects of our lives and contribute to overall well-being.
28. Technology, including gadgets, artificial intelligence, data, and cloud computing, have an impact on various aspects of our lives and can be influential in managing and understanding health conditions like EoE.
29. Even with advancements in science and technology, maintaining a balanced lifestyle remains essential, incorporating factors like home and garden, workplace wellness, and leisure activities.
30. In the face of conditions like EoE, it's important to remember that seeking professional guidance is essential for tailoring a personalized treatment plan, ensuring optimal management of symptoms and overall quality of life.

Read also: