Tutorial: Nutrition Therapy in Eosinophilic Esophagitis—Outcomes and Deficiencies

: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease that presents with symptoms of esophageal dysfunction, which vary by age. Diagnosis is made by upper endoscopy with esophageal biopsies to identify dense eosinophilic inflammation with at least 15 eosinophils per high-power field. Untreated, EoE can progress from inflammatory to esophageal remodeling with fibrosis and stricture formation. Food antigens are the primary trigger of inflammation in EoE. The most common food antigen triggers are dairy, wheat, egg, and soy. EoE can be managed with steroids or dietary elimination of food triggers. Elimination diets differ by the number of foods removed with specific nutrition implications for each diet. In addition, patients receiving swallowed steroids may have feeding dysfunction and need support for growth and nutrition intake. A multidisciplinary approach to care, including a dietitian, is integral to EoE management.