Abstract
Eosinophilic gastroenteropathies, such as eosinophilic esophagitis and eosinophilic colitis, have classically been treated with swallowed inhaled corticosteroids or oral corticosteroids. More recent studies have found elimination and elemental diets to be effective treatment alternatives to steroids. In this case series we describe the treatment of three children using nutritional management in a community setting. Elimination diets and elemental diets based on patch testing and skin prick tests reduced the eosinophil counts to normal levels in all three children. Food items which tested positive were then reintroduced while symptoms and eosinophil counts were monitored. Nutritional management of eosinophilic esophagitis and eosinophilic colitis was found to be effective in reducing symptoms. However, obstacles facing patients who choose this type of therapy include limitations due to the cost of repeated endoscopies, palatability of elimination/elemental diets and the availability of subspecialists trained in management (e.g. Allergy, Gastroenterology, and Pathology). It may be a worthwhile endeavour to overcome these obstacles as nutritional management minimizes the potential long-term effects of chronic steroid therapy.
Highlights
Over the past decade, eosinophilic gastroenteropathies have become increasingly recognized [1]
Eosinophilic esophagitis (EoE) is an inflammatory condition involving the infiltration of the esophagus with eosinophils
Less than 10 eosinophils/HPF is normal in the rectum, while a healthy cecum may contain more than 30 eosinophils/HPF [3]
Summary
Eosinophilic gastroenteropathies have become increasingly recognized [1]. Patient B is a 9 year old male who presented with stomach pains, vomiting and greater than 20 eosinophils/HPF in the esophagus He was treated with a high dose of lansoprazole (30 mg bid) for eight weeks, a repeat biopsy showed a persistence of the eosinophils. In order to begin nutritional management of his EC, patch testing was performed (see Table 1) He was started on an elimination diet which relieved his symptoms (including disruptive behaviour) within seven weeks. His abdominal pain returned, while his behavioural discrepancies and ADHD became more problematic. He refused to maintain this diet for more than two weeks and he was lost to follow up
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