Definition

Eosinophilic esophagitis or eosinophilic esophagitis (EoE) is a chronic autoimmune disease. It is characterized by inflammation and an increased presence of eosinophils in the esophagus. Eosinophils are a type of white blood cell, cells that play a role in allergic reactions. Finally, the presence of atopy, a genetic predisposition to develop allergies (e.g., food allergies or others, asthma, eczema), is one of the risk factors favoring the development of this disease.

Etiology

The cause of EoE is complex and multifactorial. The production of eosinophils can be caused by a genetic predisposition, an abnormal immune system reaction to food and/or environmental antigens, and an alteration of the integrity of the esophageal wall, leading to increased exposure to food antigens.

Diagnosis

The diagnosis of EoE is usually made through endoscopy and biopsies.

Symptoms

The symptoms of EoE can vary depending on the age of the individuals affected by this disease. In adults, theymay include difficulty swallowing solids (notably meats, rice, and some drier foods), the sensation of food stuck after eating, vomiting, reflux, and abdominal or chest pain. Other symptoms may be more difficult to detect, such as eating slowly, excessive chewing, and drinking throughout the meal to help swallow food.

In young children, growth delays, vomiting, food refusal, and difficulties transitioning to more solid foods may be observed.

Treatment

Treatment usually includes medications and dietary modifications prescribed by the gastroenterologist. The involvement of a nutritionist and an allergist (if you suffer from allergies) can be helpful. The goal of treatment is to alleviate your symptoms and reduce the number of eosinophils in the affected tissue or eliminate them completely. Treatments must be individualized, as each case has its own individual particularities.

Nutritional treatment

Nutritional treatment of EoE generally involves the implementation of an elimination diet that can be based on allergy tests or empirical (predefined).

In the case of an elimination diet based on allergy tests, all food allergens identified by the tests are removed from the diet.

In the case of an empirical elimination diet, nutritional treatment consists of progressively eliminating two or more groups of food allergens depending on the individual's response at each stage.

The first step is the implementation of a two-food elimination diet (TFED). The two foods eliminated with the TFED are milk and wheat.

If the TFED is not sufficient, the second step is to progress to a four-food elimination diet (FFED). Eggs and legumes, including soy, are then added to the foods eliminated with the TFED.

Finally, if the FFED is still not sufficient, the third and final step is to progress to a six-food elimination diet (SFED). The two new categories of foods eliminated are nuts, including peanuts, as well as fish and seafood.

Additionally, during nutritional treatment, it is also important to ensure that individuals' vitamin and mineral needs are met. Taking allergen-free supplements may be necessary.

Finally, the elimination diet is generally followed for a period of six to eight weeks. Then, individuals undergo an endoscopy and biopsies to observe their response to nutritional treatment. Depending on the results obtained, a protocol for reintroducing eliminated allergens may be initiated or not. When the response to treatment is positive, reintroduction is done gradually, one allergen at a time.

References

1. Bouthillier, Lise. January 2019. "Digestive Tract Diseases." NUT 2047 – Clinical Nutrition 2. Montreal: University of Montreal.
2. https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/troubles-%C5%93sophagiens-et-de-la-d%C3%A9glutition/%C5%93sophagite-%C3%A0-%C3%A9osinophiles
3. https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/maladies-de-l%E2%80%99%C5%93sophage-et-de-la-d%C3%A9glutition/%C5%93sophagite-%C3%A0-%C3%A9osinophiles
4. https://badgut.org/centre-information/sujets-de-a-a-z/atteintes-gastro-intestinales-a-eosinophiles/?lang=fr

Article written by:

Marie-Noël Marsan, written in 2021.