Eosinophilic Esophagitis, also known as EoE, is a disorder of the esophagus in which eosinophils cause inflammation of the lining of the esophagus. Eosinophils (allergy cells) build up in the lining of the esophagus causing inflammation in the esophagus. Certain foods and environmental allergens are known to trigger this disorder.
- Difficulty swallowing
- Poor weight gain
- Abdominal pain
- Difficulty with feeding, including feeding refusal and feeding intolerance
- Reflux symptoms
- Food impaction (food gets stuck in the throat)
To test for EoE, an upper endoscopy with a biopsy (taking a small piece of tissue to be examined under a microscope) is necessary. The biopsies can diagnose EoE but your doctor may have your child undergo allergy testing through skin prick tests or a blood test to determine specific foods that may affect your child.
Treatment of EoE may involve dietary changes, medications or a combination of both. Although there is no specific medication especially for EoE, medication is sometimes used. Corticosteroids, for example, have been helpful for patients and may be taken orally or through an asthma inhaler.
If your doctor discovers that you are allergic to a particular food, he may have you avoid that food. Sometimes no specific allergy is found and a dietitian is needed to help with the 6 food elimination diet.
Your doctor may want your child to undergo additional upper endoscopies with biopsies to see if the dietary changes and/or medications are helping.
6 Food Elimination Diet
Your physician may place your child on the 6-food elimination diet for 2-3 months depending on your child’s EoE and symptoms. The diet removes the top 6-food allergens including milk/dairy products, eggs, wheat, soy, peanut/tree nut, and shellfish/fish.
Foods your child can eat:
- Game Meats
- Potato (white and sweet)
- Most Gluten Free Foods (does not contain soy, or nut flours)
- Fruits and Vegetables
- Gluten free oats
- Oils (olive, sunflower, canola)
- Most coffee and tea
- Rice milk
- Coconut milk
*Consider meeting with a registered dietitian for a nutritional consult to ensure your child is meeting all nutritional needs.
Reading Food Labels
Food labels are on all packaged foods. Read all food labels carefully as manufacturers may change ingredients at any time. When in doubt, call the food manufacturer to see if the food contains any allergens.
Avoid cross contamination with your child’s food. This can occur when a food comes into contact with another food or leftover residue. It is difficult to determine the amount of a particular food that can cause a reaction in EoE because the symptoms are not immediate after eating the food. Be as careful as possible to avoid the occurrence of cross contamination with food.
Common sources for cross contamination:
- Cutting boards, pots and pans- Wash with soap and water
- Utensils- Use separate utensils for condiment jars
- Bulk Bins- Purchase prepackaged items
- Fryer Oils-Sauté items at home, avoid fried foods when eating out
- Grill-Wrap foods in foil before placing on the grill, avoid ordering grilled items at restaurants unless prepared on a clean surface
- Deli slicers-Purchase prepackaged meats or from a deli that uses separate slicers for meat and cheese
- Toaster- Use a separate toaster for wheat free breads, toast bread on foil using the oven set at broil
EoE Elimination Diet- Avoid the following foods:
· Cow’s milk
· Half and half
· Sour Cream
· Rennet Casein
· Egg substitutes
· Beware of baked goods, puddings
· Breaded meats, meatballs, meatloaf
· Pizza crust
· Most flours, all purpose, self rising and cake flour
· Purchase gluten free foods made from tapioca, rice and potato products
· Soy sauce
· Tofu Quorn
· Soy flour
· Soy fiber
· Soy protein
· Textured Vegetable Protein
· May in broths, vegetable gums and starches
Nuts and Tree Nuts
· Avoid all nuts including peanuts
· Seed are okay
· Coconut and coconut milk is okay
· Nut meal
· Nut meat
· Nut Milk
· Nut extracts
· Nut paste
· Peanut oil
Seafood and Shellfish
· Avoid all fish
· Shrimp, prawns
· Check imitation fish
· Fish stock/sauce
· Seafood flavoring
Esophagitis-esophagus-middle third of the esophagus.