FCAAIA Notes: There is still a great deal of debate about the best way to treat eosinophilic esophagitis (EoE). I believe that debate will continue because one size does not fit all.
When an individual food or a limited number of foods are identified as triggers, the avoidance diet might be sufficient. For others, nothing but extreme dietary intervention (few or no solids and an amino acid based formula) is very useful. That is an unpleasant and impractical alternative. Topical esophageal steroids (e.g., steroid inhalers or nebulizer medications that are swallowed, not inhaled) are the first choice of medications for EoE.
So what foods to eliminate when trying? I think there are several reasonable approaches Continue reading “FOOD ELIMINATION DIETS ARE EFFECTIVE FOR LONG-TERM TREATMENT OF ADULTS WITH EOSINOPHILIC OESOPHAGITIS”
FCAAIA Notes: Patients with eosinophilic esophagitis (EoE) tend to be highly atopic/allergic (or at least tend to have a lot of positive skin tests to aeroallergens), although it is probably only a small proportion whose EoE is triggered by aeroallergens. I don’t think there is any question that some patients have seasonal worsening of their EoE in association with worsening seasonal allergy symptoms. In, fact I have had quite a few such patients myself.
Although it makes intuitive sense that those patients would improve on allergy shots for their pollinosis, there are no data confirming or refuting that theory. Continue reading “SEASONAL EXACERBATION OF ESOPHAGEAL EOSINOPHILIA IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS AND ALLERGIC RHINITIS”
FCAAIA Notes: Eosinophilic Esophagitis (EoE) has been recognized with increasing frequency in a variety of settings. It can present in a variety of ways, in part depend on the patients age. In some, it presents as gastroesophageal reflux unresponsive to high doses of reflux medications. In infant it can present as food refusal and failure to thrive. In older children and adults, it might just present as intermittent food impaction with swallowing.
There is a lot of interest and research in oral desensitization to foods (OIT) and to sublingual (under the tongue) immunotherapy (SLIT) for nasal allergies. Continue reading “EOE DEVELOPED IN PATIENTS WITH IGE-MEDIATED FOOD ALLERGY AFTER OIT”
FCAAIA Notes: Eosinophilic esophagitis (EoE) is a relatively newly described condition that has been the focus of intense research for the past 10 or more years. It can present as severe gastro-esophageal reflux (GER) unusually resistant to typical GER treatments. However, it can also present as food refusal (especially in young children), weight loss, and a sensation of food getting “stuck” while swallowing. The diagnosis is often suspected, but must be confirmed by endoscopy and biopsy. An excellent review of EoE can be found in another Medscape article.
Sometimes, EoE is caused by a particular food or foods, in which case elimination of that food is essential. Other times, it is independent of diet. Continue reading “STEROIDS VERSUS DIETARY THERAPY FOR THE TREATMENT OF EOSINOPHILIC ESOPHAGITIS”