EoE- When Your Esophagus is Angry

Published on Tuesday, August 23, 2022 by Kari Tallent

Eosinophilic Esophagitis, commonly referred to as EoE, is recognized as a chronic allergic/immune condition that negatively impacts the functionality of the esophagus.

Eosinophils are a specific type of disease-fighting white blood cell that fights parasitic infection, allergic reactions, or cancer, but can be bad news in the esophagus. EoE has only been identified since the early 90s and is now one of the major illnesses that can impact the digestive system.

In fact, EoE and GERD (gastroesophageal reflux disease) have a complicated history with many sufferers of EoE being diagnosed with GERD but potentially not suffering from GERD. On the other hand, suffering from EoE can increase your risk of developing GERD and for those who already do suffer from GERD, there is a risk of EoE development as well (J. Gastroenterol. Hepatol., 2019).

You might be thinking, oh white blood cells are great, they fight bad things, and generally, you would be right, but when this happens you get a very angry esophagus. One of the major problems with EoE is that a large number of eosinophils can gather in the esophageal lining (this build-up can be a reaction to foods, allergens, or acid reflux) and cause inflammation. This inflammation can lead to the narrowing of the esophagus, making swallowing difficult or food can become impacted causing a medical emergency.

How does this happen?

In the Fall and Spring EoE is diagnosed more frequently due to the excess pollen in the air. This pollen is ingested and trapped in the esophagus. Another factor is a reaction to food allergies that worsen over time. Food allergen/sensitivity reaction is what I will be focusing on throughout the rest of this article since it is one of the major causes of EoE.

Unlike typical food allergies that can elicit fairly immediate reactions, in EoE, the reaction is delayed and develops over days. This makes identifying the trigger food challenge. Allergen elimination diets are often prescribed to calm the esophagus's inflammatory response and identify the food or foods that may be triggering the response. This is time-consuming as it may take a few weeks for the esophagus to fully heal through the elimination of common food allergens.

I always tell clients they have to allow things to calm down before we can get everything working again.

The top food allergens are dairy products, eggs, soy, and wheat. These foods would be eliminated first to determine if there is a sensitivity to any of them. Other food allergens such as peanuts, tree nuts, and fish/shellfish may also be eliminated.

When all allergens are eliminated it is called an SFED or Six Food Elimination Diet. Whether you eliminate all food allergens or just the top four, plan on following this diet for up to six to eight weeks. After time has passed and inflammation has resolved, one food allergen is reintroduced at a time. This will be over 1-2 weeks for each food to be eliminated, to determine if there is an eosinophilic response. Other tests can be performed such as a skin prick test, and blood tests, but these tests aren’t as accurate for identifying foods that trigger EoE because it is not caused by IgE antibodies which are what the tests read.

In some cases, elemental diets are followed where amino acid (hypo-allergenic) formulas are consumed either via drinking or through a feeding tube. In children, a feeding tube is often placed to get the volume needed to meet calorie needs, but this is only used when children have multiple food allergies and have failed other treatment methods.

Since Identifying EoE and trialing various treatment methods over time, elimination diets are the most effective method of resolution. Fortunately, finding products to replace your favorite items has become much easier. From waffles to yogurt, to condiments, sauces, milk alternatives, and even vegan egg recipes, you can still find ways to satisfy your culinary pallet. Of course, it may not be ideal, but it’s nice to know when your esophagus is angry, there is a solution to a better quality of living and eating.