Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
What about elimination diets for treating eosinophilic esophagitis?
The leading theory about the cause of eosinophilic esophagitis is that it represents allergy to some protein found in food. Evidence has accumulated in children that diets that eliminate the allergy-inducing food can result in reversal of the esophagitis and disappearance of the eosinophils. Similar evidence now is accumulating in adult patients. Doctors have used elimination diets to define what the allergy-inciting foods might be.
There are several ways in which elimination diets can be attempted. The first is to do skin and blood tests looking for specific foods that might be causing the allergy and then eliminating these foods from the diet. The second is to eliminate the major groups of food to which allergy is common, specifically milk protein,
soy, peanut/tree nuts, eggs, wheat, and seafood. Finally,
individuals may be placed on an elemental liquid diet (a diet of digested food that no longer contains proteins that can provoke allergy), and then different foods can be added to the diet until the allergy-inducing food is found. None of these elimination diets are easy for physicians to perform or for patients to follow, especially children, and each has its pros and cons. Nevertheless, if one or two foods can be found that are responsible for the allergy, a near-normal diet can be resumed, and the need for medications can be eliminated
What is the future of eosinophilic esophagitis?
Eosinophilic esophagitis in adults is a newly-recognized disease. Therefore,
understanding of the cause(s), natural history, diagnosis and management is
limited and will evolve over the coming years. Currently, the recommended
treatments (for example, with oral fluticasone propionate) are based on a
limited number of small studies. More studies involving larger numbers of
patients followed for longer periods of time are necessary to determine the
long-term efficacy and safety of treatment.
Montelukast (Singulair) is an oral
leukotriene receptor antagonist that
is used for treating asthma and seasonal allergic rhinitis (hay fever).
Leukotrienes are a group of naturally occurring chemicals in the body that
promote inflammation in asthma, seasonal allergic rhinitis, and other diseases involving allergy. They
are formed by cells, released, and then bound to other cells that participate in
inflammation. It is the binding to these other cells that stimulates the cells
and promotes inflammation. Montelukast blocks the binding of some of these
leukotrienes and has been used with success in treating a small number of
patients with eosinophilic esophagitis. It improves symptoms but does not reduce
teh numbers of eosinophils. More studies are needed.
Cromolyn is a synthetic compound that is used to prevent allergic reactions.
Many of the symptoms and signs of allergic reactions are caused by chemicals,
for example, histamine, that are
released from mast cells, a type of cell that is found throughout the body as
well as in the lungs, nose, and eyelids. Cromolyn works by preventing the
release of these chemicals from the mast cells. Cromolyn is inhaled to prevent
episodes of asthma due to allergy. It also is used as a nasal inhaler to treat seasonal allergic rhinitis (due to inflammation
of the lining of the nose) and as an ophthalmic (eye) solution to treat
allergic conjunctivitis (due to inflammation of the lining of the eyelids). More studies
are needed to determine whether cromolyn is effective in treating
eosinophilic esophagitis.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Gangrene may result when blood flow to a tissue is lost or not adequate to keep the tissue alive. There are two types of gangrene: wet and dry. All cases of wet gangrene are infected by bacteria. Most cases of dry gangrene are not infected. If wet gangrene goes untreated, the patient may die of sepsis and die within hours or days. Dry gangrene usually doesn't cause the patient to die. Symptoms of dry gangrene include numbness, discoloration, and mummification of the affected tissue. Wet gangrene symptoms include swelling, pain, pus, bad smell, and black appearance of the affected tissue. Treatment depends upon the type of gangrene and how much tissue is compromised by the gangrene.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
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