Eosinophilic Oesophagitis: what, why and what now?
Eosinophilic oesophagitis (EoE) is a condition in which the oesophagus (gullet) becomes inflamed as a result of an allergic reaction.
Complications range from mild (i.e. tickling sensation in the throat) to severe (i.e. food bolus blocking the oesophagus or oesophageal tear).
It can only be diagnosed through having an endoscopy with multiple biopsies (tissue samples that are then examined under a microscope). If your oesophageal lining contains lots of eosinophils (eosinophil count above 15 is characteristic to EoE), you will be diagnosed with this disease.
EoE can be treated with topical steroid therapy or diet, but some people may also require their oesophagus to be dilated (if they have permanent narrowings aka strictures).
Your gastro doctor will go through pros and cons of steroid and diet therapy, but it’s up to you which one you choose. Different people will prefer different management options and that’s OK, the most important thing is to keep in close contact with your team and ensure that you are getting support and monitoring that you need. If you choose to explore dietary management, ensure that your dietitian is liaising with your gastro team- it’s crucial for ensuring appropriate monitoring and management of the condition.
Although the mechanisms are not yet well understood, food allergens such as milk, soya, wheat and egg often trigger this condition. It is classified as a ‘non IgE mediated allergy’ so allergy tests (skin prick tests and specific IgE blood tests) are not always able to identify the foods that trigger the EoE. Currently the most effective dietary treatment for EoE is a six food elimination diet (SFED), but you may be recommend a four food elimination diet (FFED) depending on the results of the initial assessment. Whether it’s a SFED or FFED, the diet will usually need to be followed for 6 weeks. If symptoms have improved, foods are then reintroduced one at a time to identify the trigger allergens.