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Your Guide to Eosinophilic Esophagitis

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A Guide to Eosinophilic Esophagitis Treatment

Medically Reviewed By Marc Meth, MD, FACAAI, FAAAI

Treatments for eosinophilic esophagitis (EoE), a chronic inflammation of the esophagus, include dietary changes and medications to relieve the symptoms.  Read on to learn more about eosinophilic esophagitis treatment.

Dietary changes

Fried eggs set against a yellow background
Studio XMI/Stocksy United

Eosinophilic esophagitis (EoE) usually involves an overreaction of the immune system to particular foods. Avoiding the foods that trigger EoE may improve symptoms.

However, determining which foods to avoid can take time and experimentation. Different people have different food triggers.

There are three main approaches to EoE diet plans:

  • 2- 4- or 6-food elimination diets
  • elemental diet
  • targeted elimination diet

2-, 4- or 6-food elimination diets 

Six foods Trusted Source PubMed Central Highly respected database from the National Institutes of Health Go to source tend to cause the majority of food allergy symptoms in people with EoE:

  • dairy products
  • eggs
  • wheat
  • soy
  • peanuts/tree nuts
  • fish/shellfish

Your doctor may begin with the 2-food elimination diet, which restricts milk and wheat. If your symptoms don’t improve, you can try the 4-food elimination diet, which involves eliminating:

  • eggs
  • legumes, including peanuts
  • milk
  • wheat

If necessary, you can progress to the 6-food elimination diet.

In the traditional 6-food elimination diet, you remove all those foods from your diet for several weeks. Then, a physician will reassess your symptoms and esophagus.

Over the next few weeks, each food is reintroduced one at a time to see whether symptoms recur. Because this diet can be challenging to follow and results often take weeks or months, you may want to work with a registered dietitian to create an appropriate eating plan.

Elemental diet 

The elemental diet removes all potential allergen sources from your diet. Your doctor will have you drink an amino acid formula, sometimes with one or two simple foods unlikely to trigger symptoms.

Typically, an elemental diet is used if food allergy testing is negative and other treatments have been ineffective. It’s most commonly used in the pediatric population. Weeks on the elemental diet can give the esophagus time to heal before reintroducing food.

Targeted elimination diet

For the targeted elimination diet, your doctor will order food allergy testing first. Then, you will eliminate any foods shown to be an allergen from your diet.

This type of diet is less commonly used. According to the American Academy of Allergy, Asthma, and Immunology, food allergy testing can be difficult due to the possibility of both false positive and false negative results.

Many allergy tests assess immunoglobulin E (IgE) levels. IgE is an antibody produced by the immune system in response to an allergen.

However, researchers believe that EoE is likely not an IgE-mediated disorder. It produces delayed reactions to allergens and chronic symptoms rather than immediate ones.

Allergy tests that measure IgE levels are not reliable for identifying EoE triggers. Your doctor may have you begin an elimination diet without testing.

Medications

Prescription medication can ease the symptoms of EoE. Commonly prescribed medications include:

  • Topical corticosteroids: Steroids decrease inflammation. People with EoE may find relief using an inhaled or swallowed steroid medication.
  • Acid suppressors: Acid-suppressing medications, including omeprazole (Prilosec) and lansoprazole (Prevacid), can decrease reflux and increase comfort.
  • Allergy medication: People with EoE and diagnosed allergies may need daily medication.

Also, the Food and Drug Administration (FDA) Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source has recently approved dupilumab (Dupixent) for people with EoE over age 12 who weigh at least 88 pounds. Patients can inject this medication weekly to reduce inflammation and make swallowing easier.

Dilation

If EoE has caused significant narrowing of the esophagus, your physician may need to dilate or enlarge it. This procedure can be done during an endoscopy, an examination of the esophagus with a lighted tube. Dilation may make swallowing easier and make food less likely to become stuck.

It will likely take time to determine which treatments are most effective for managing your symptoms. Some of the above treatments are often combined to achieve the best results. Most people with EoE thrive with appropriate medical treatment.

FAQ

Marc Meth, M.D., FACAAI, FAAAI, reviewed the answers to these common questions about EoE.

Will eosinophilic esophagitis go away?

There is currently no cure for EoE. You may be able to manage your symptoms by removing food triggers from your diet and taking medication. If your esophagus has narrowed, your doctor may need to dilate it.

What triggers eosinophilic esophagitis?

Foods, airborne allergens, or other allergic conditions may trigger the immune-system reaction associated with EoE.

What are the symptoms of eosinophilic esophagitis?

People with EoE can experience difficulty swallowing, heartburn, food becoming stuck in the esophagus, and central chest pain. Children with the condition may also experience vomiting, abdominal pain, and reduced growth.

Summary

EoE treatment usually begins with dietary modifications. Your doctor may recommend eliminating up to six of the most common food allergens from your diet for weeks to see whether your symptoms improve.

Some people may also require medication — like acid-suppressing drugs, corticosteroids, and allergy medications — to manage their symptoms. In cases where the esophagus has become significantly narrowed, a doctor may need to dilate it.

Talk with a doctor about ways to manage EoE.

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  1. Carr, S., et al. (2018). Eosinophilic esophagitis. https://aacijournal.biomedcentral.com/articles/10.1186/s13223-018-0287-0
  2. Eosinophilic esophagitis. (2020). https://medlineplus.gov/eosinophilicesophagitis.html
  3. Eosinophilic esophagitis. (2022). https://www.aaaai.org/Conditions-Treatments/related-conditions/eosinophilic-esophagitis
  4. FDA approves first treatment for eosinophilic esophagitis, a chronic immune disorder. (2022). https://www.fda.gov/news-events/press-announcements/fda-approves-first-treatment-eosinophilic-esophagitis-chronic-immune-disorder
  5. Roussel, J. M., et al. (2022). Eosinophilic esophagitis. https://www.ncbi.nlm.nih.gov/books/NBK459297/

Medical Reviewer: Marc Meth, MD, FACAAI, FAAAI
Last Review Date: 2023 Feb 9
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