Tutorial: Nutrition Therapy in Eosinophilic Esophagitis—Outcomes and Deficiencies

Bashaw, Hillary; Schwartz, Sally; Kagalwalla, Amir F.; Wechsler, Joshua B.

doi:10.1002/jpen.1738

Cited by 19 publications

(12 citation statements)

References 52 publications

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“…Adequate dietary education and review from a dietitian supplemented by comprehensive patient resources are essential to successful implementation of elimination diets in EoE. 31,32 Barriers to compliance with elimination diets include financial resources, inadequate social support systems, patient motivation, and access to appropriate substitute foods. 11,26 Our findings have shown that majority of foods required for the 2-, 4-, and 6FED can be sourced from a major supermarket; however, patients may require support from a dietitian to identify these foods and incorporate them into their diet.…”

Section: Discussionmentioning

confidence: 99%

“…Without the modelling adjustments made by experienced accredited practising dietitians, the 4‐ and 6‐FED meal plans were nutritionally inadequate in iodine, riboflavin, and calcium. Adequate dietary education and review from a dietitian supplemented by comprehensive patient resources are essential to successful implementation of elimination diets in EoE 31,32 . Barriers to compliance with elimination diets include financial resources, inadequate social support systems, patient motivation, and access to appropriate substitute foods 11,26 .…”

Section: Discussionmentioning

confidence: 99%

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Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

Sheedy

Patel

Porter

et al. 2021

Nutrition & Dietetics

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This study aimed to investigate and compare the cost, affordability, and accessibility of three elimination diet approaches for the treatment of patients with eosinophilic esophagitis: the two-, four-and six-food elimination diets and with comparison to a standard diet.Methods: An evidence-based modelling process was undertaken for costing and accessibility, including the development of three hypothetical reference families; four food baskets were modified from an established benchmark for each diet. Baskets were costed across eastern Melbourne, Australia. Affordability was modelled using two incomes: the equivalised disposable household income and welfare payments for reference families. Affordability was defined as <30% of the median weekly household income and food stress defined as >25% of a median weekly household income. Results: All elimination diets were significantly more expensive than a standard diet and may be unaffordable for those receiving welfare. Prices significantly increased as the number of food allergens eliminated increased. Most items for a two-food elimination diet were available at major supermarkets; however, items for nutritionally complete four-and six-food elimination diets required a visit to a second store. Conclusion:A step-up approach, commencing with a two-food elimination diet, instead of starting with a six-food elimination diet, may alleviate affordability barriers for most family types, which may enhance compliance. Clinicians should consider family type, financial situation, as well as accessibility of allergen-free foods in the patient's residential area when deciding on the most appropriate dietary or therapeutic treatment approach for eosinophilic oesophagitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

Sheedy

Patel

Porter

et al. 2021

Nutrition & Dietetics

View full text Add to dashboard Cite

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“…If failure to thrive or nutritional deficiencies are suspected, biochemical tests (i.e., bone and iron metabolism, serum albumin, and prealbumin) should be performed. When a micro- or macronutrient deficiency is confirmed, nutritional supplements should be promptly provided ( Table 4 ) ( 66 ).…”

Section: Nutritional Considerations and Patient Educationmentioning

confidence: 99%

Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach

et al. 2022

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Eosinophilic esophagitis (EoE) is a chronic allergic disease defined by a marked eosinophilic inflammation and symptoms of esophageal dysfunction. EoE is a heterogeneous disease and severely impacts the quality of life of affected patients. The current therapeutic management of EoE is based on two cornerstones: medication and diet therapy, both effective but limited by several critical issues. The choice of one or the other therapy might depend on the different disease phenotypes (allergic vs. non-allergic, inflammatory vs. fibro-stenotic), patient's age (adult vs. childhood-onset), food habits, patient/family preference, and familiar financial resource. Diet therapy is a successful treatment but limited by low patient adherence, the need for several endoscopies, food restrictions, psychosocial impact, and potential nutritional deficiencies. All these limitations could be effectively overcome with multidisciplinary and personalized management. This review summarizes the most recent evidence on the dietary elimination approaches and will provide a practical guide to clinicians in managing and implementing dietary therapy for patients with EoE.

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“…The basic form is the six-food elimination diet (SFED), based on elimination of milk protein, eggs, wheat, soy, peanuts and sea food. Compared to other empiric elimination diets, such as the four-food elimination diet (exclusion of milk protein, eggs, wheat and soy) or the two-food elimination diet (exclusion of milk protein and eggs), the SFED has been proven to be highly effective in inducing remission [ 14 , 15 , 16 ]. After achieving remission, eliminated allergens should be reintroduced into the diet one by one (step-down approach), and a control biopsy should be performed after each reintroduction to detect the potential food trigger.…”

Section: General Treatment Recommendations For Eoementioning

confidence: 99%

Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

Główczewski

Krogulska

2022

JCM

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Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterised by eosinophilic inflammation and esophageal dysfunction symptoms. The recommended first-line treatment options are proton pump inhibitors and swallowed topical steroids (STS). However, current recommendations regarding STS are based on relatively few studies employing various doses and formulations. Our aim was to review the STS formulations currently used in the treatment of eosinophilic esophagitis, to demonstrate in a practical way the variety of exiting application methods, and to present emerging options for STS delivery to the esophagus. After the literature review, we established that the three most commonly used STS formulations include mist from an inhaler, viscous suspensions compounded with vehicles for oral use, and a recently introduced proprietary medication in the form of orodispersible tablets. Several drug delivery technologies with potential use in EoE are under investigation. To ensure optimal adherence, the choice of formulation should be based on efficacy, patient preferences and experience of the clinician, as well as current recommendations. Further studies are needed to compare the efficacy and acceptability of existing STS types, and to develop new, well-tolerated and effective drug formulations.

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Tutorial: Nutrition Therapy in Eosinophilic Esophagitis—Outcomes and Deficiencies

Cited by 19 publications

References 52 publications

Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

Cost and accessibility of empiric food elimination diets for treatment of eosinophilic oesophagitis

Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach

Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

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