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.

Should you take a probiotic alongside a low FODMAP diet?

This question comes up in my clinics all the time and I thought I'd share my thoughts on this here...It is not yet known whether it is better to take a probiotic alongside a low FODMAP diet or not. In 2016, Staudacher and colleagues published a randomised controlled trial looking at the effects on IBS symptom improvement and faecal bacteria with a low FODMAP diet and probiotics (VSL#3) versus a low FODMAP diet alone. IBS symptoms improved to the same extent in both groups, suggesting that VSL#3 did not add any further benefit. However, VSL#3 in combination with low a FODMAP prevented the decline in the numbers of bifidobacteria (beneficial bacteria) that is usually seen in those following a low FODMAP diet. We do not yet know whether the beneficial bacteria comes back with the reintroduction of high FODMAP foods at the later stages of the diet or whether this can only be achieved by adding in a probiotic...


Do you suspect a food intolerance?

If you suspect you have any other food intolerances, you should see a dietitian who will be able to support you in identifying the culprit for your symptoms. A dietitian’s role is to carefully assess your diet, eating patterns and other potential factors that may impacting on your symptoms and propose dietary/ lifestyle manipulations.
If you are likely to have food intolerance, you may be offered to complete an elimination diet. They require dedication and time, but if done properly, can be invaluable in helping you to find out whether you have any particular food intolerances and how to best cope with these. your digestive symptoms may arise from years of dieting, in which case elimination diets may make things worse, not better. Make sure you see a dietitian with experience in gastroenterology and disordered eating to receive the support that you need.

What are probiotics?

Defined by the World Health Organisation as “Live microorganisms that when administered in adequate amounts, confer a health benefit on the host”. Probiotics are described first by genus, then species and then by strain (i.e. Bifidobacterium infantis 35624).

There are significant differences in their functions even at the strain level; therefore, for example, only because this specific strain (Bifidobacterium infantis 35624) was shown to benefit people with IBS (human trials), it does not mean that all other Bifidobacterium strains will have the same effect!