L’œsophagite à éosinophiles

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 responding to allergic reactions. Finally, the presence of atopy, a genetic predisposition to develop allergies (eg: food or other allergies, asthma, eczema), represents 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 genetic predisposition, an abnormal reaction of the immune system to food and / or environmental antigens and alteration of the integrity of the esophageal wall, leading to increased exposure to food antigens.

Diagnostic

Diagnosis of EoE is usually made via endoscopy and biopsies.

Symptoms

Symptoms of EoE can vary depending on the age of individuals with the disease. In adults, theymay include difficulty swallowing solids (especially meats, rice, and some drier foods), feeling like food is stuck after eating, vomiting, reflux, and abdominal or chest pain. Other symptoms may be more difficult to spot, such as eating slowly, chewing excessively, and drinking throughout the meal to help swallow food.

In young children, there may be stunted growth, vomiting, refusal of food, and difficulty in transitioning to more solid foods.

Treatment

Treatment usually includes drugs and diet modifications, prescribed by the gastroenterologist. Help from a nutritionist and allergist (if you have allergies) can be helpful. The goal of treatment is to reduce your symptoms and reduce the number of eosinophils in the affected tissue or to eliminate them altogether. Treatments must be individualized, since in this case each has its own individual characteristics.

Nutritional treatment

Nutritional treatment for EoE usually includes initiation of an elimination diet which may be based on allergy testing or empiric (predefined).

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

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

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

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

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

In addition, during nutritional treatment, it is also important to ensure that the vitamin and mineral needs of individuals are met. It may be necessary to take allergen-free supplements.

 

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

 

References

  1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
  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% A9osinophils
  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 % 93sophagitis-% C3% A0-% C3% A9osinophils
  4. https://badgut.org/centre-information/sujets-de-a-a-z/atteintes-gastro-intestinales-a-eosinophiles/lang=frr

Article written by:

Marie-Noël Marsan, Nutritionist

 

 

O