Rare conditions with nutrition implications: Eosinophilic esophagitis

Eosinophilic (ee-oh-sin-oh-fill-ick) esophagitis (EoE) is a newly-recognized condition that has been diagnosed more and more often. It may require care from an allergist and a gastroenterologist to diagnose and treat. Dietitians also have key roles in the treatment of the condition.

What is eosinophilic esophagitis?

EoE is characterized by inflammation and the presence of white blood cells (eosinophils) in the esophagus. This chronic condition can be diagnosed at any age — from early childhood to adulthood. Symptoms of the disease can vary by age. Children may experience inadequate growth, vomiting, abdominal pain, difficulty swallowing, or refuse to eat. Older children and adults may exhibit difficulty swallowing caused by narrowing of the esophagus.

EoE is diagnosed with an upper endoscopy and biopsy. It often goes hand-in-hand with food or environmental allergies. Once EoE is diagnosed, the patient may undergo further allergy testing. At this time, there is no cure for EoE. If allergies are detected, it is important to treat those underlying conditions.

Nutrition implications of eosinophilic esophagitis

The nutrition implications of EoE are essentially two-fold. First, EoE often manifests in symptoms that impact nutritional intake, specifically, refusal to eat, difficulty swallowing, abdominal pain, and vomiting. Coping with and controlling those symptoms are important steps to prevent deterioration of nutrition status.

Second, food allergies are often diagnosed concurrently with EoE. If this represents the root cause or a contributing factor of the EoE diagnosis, these food allergens must be eliminated from the diet. Of course, this process can be complex and can also jeopardize nutrition status, if many food allergies are present. Removing offending foods while meeting all nutritional needs requires guidance from a dietitian.

How dietitians can help

Because of the nutrition implications of EoE, particularly when food allergies are involved, a dietitian is a key player in the management of the condition. When EoE is affecting a child, the dietitian will track growth and ensure no nutritional deficits are present. When it comes to food allergies, dietitians are the highest-qualified clinicians to educate clients and families regarding elimination diets, food reintroduction, reading food labels, recipe modifications, and more.

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References

American Academy of Allergy, Asthma, and Immunology. Eosinophilic esophagitis (EoE). https://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis. Accessed May 30, 2019.