Ask the Nutritionist – Eosinophilic Esophagitis

Posted 12.9.10 | Christine Graham-Garo

Question: I’ve been hearing a lot lately about eosinophilic esophagitis. Can you explain what it is and how it is treated?


Eosinophilic esophagitis, often referred to as EoE, is an inflammatory, gastrointestinal condition typically caused by food allergies. The disease causes swelling of the esophagus due to a build-up of white blood cells known as eosinophils. This inflammation causes painful and severe symptoms including difficulty swallowing, nausea, vomiting, regurgitation, severe heartburn, abdominal or chest pain and weight loss.

Doctors aren’t sure of the exact cause of EoE, but recent research has shown that it may be related to other allergic diseases such as hay fever, asthma and food allergies.

There is currently no cure for EoE, but medical and nutrition therapy can alleviate symptoms and prevent further damage to the esophagus. For the short term, standard medications such as steroids are successful in resolving symptoms and reducing the number of eosinophils. Because of concern with side effects associated with long term steroid use, long term treatment requires nutrition therapy.

Research has shown that an elemental diet with formulas like Neocate and E028 Splash are successful in reducing symptoms and eosinophils in children with EoE. If a total elemental diet cannot be used, then primary nutrition therapy is a food elimination diet where children avoid all confirmed allergic foods, which could include dairy, egg, wheat and tree nuts. Elimination diets are often so restrictive that they may result in poor intake of essential nutrients, like protein, calories, calcium and vitamin D. For this reason, children on elimination diets also benefit from adding an elemental formula, which provides a valuable source of essential nutrients missing in most elimination diets.

Read Comments (4)

  • 2011-10-17 | Kris

    My 18 year old has been diagnosed with EoE. We had all the tests and he is allergic to milk, egg all 90 terms, soy, soy lethin, bannanas, strawberry, cabbage of any kind, fish of any kind, vinager, catalope,wheat, rye, buckwheat, oat, apples, grapes and the list keeps getting added to. We tried the EO28 splash and he wasn’t able to tollerate it he got an imediate headach and diarehha. I am guessing the vit D in it may be the problem because he is allergic to all foods with Vit D. He is missing out on so much and we are running out of ideas. We see our GI specialist next week but I am wondering if some kids can actually be allergic to all foods and the elemental diet? What can be done for that?

  • 2011-10-25 | Christine Graham-Garo

    Hi Kris,
    How fustrating. It is extremely rare to hear of a child who does not tolerate any elemental formula on the market. We hear at times of a child who tolerates one (perhaps the Neocate Jr unflavored) and not the other (perhaps flavored). But we try to encourage that you trial at least a few other formulas in hopes one may help. Have you tried the Neocate Jr Unflavored? For these extreme cases where the child is not tolerating any elemental formula, the next option (and this would have to be initiated by your doctor or dietitian) is to use a Modular approach. This means that instead of using one formula for all their nutrient needs, you use seperate products to meet the Protein, carbohydrate, fat, and vitamin and mineral needs. For example, we offer a product called the Complete Amino Acid Mix which would be used for the protein. The mixture would have to be calucated by a registered dietitian to make sure it is just right for your son. I have heard it works well for some kiddos. I would encourage you to call us here at Nutricia and speak to a Nutritionist. (1-800-NEOCATE). We would be happy to speak with you further on this to help in any way we can.
    Best wishes,

  • 2013-04-03 | Aimee Tubbs

    I have the same question. What can be done for those that are allergic to almost all foods and can’t tolerate the formula? I have two family members with a very similar situation. We tried two trials of the elemental diet and it was miserable. We used the unflavored and by the end of the two week trial they preferred going without anything to taking the formula. It gave them no benefit or relief and the taste was unbearable. What can be done to help them? We are at a complete loss.

  • 2015-02-14 | Rob McCandlish, RDN

    Hi Aimee,
      For some individuals, it’s a matter of trial and error with the available formula options. Especially with artificially flavored formulas, some people may tolerate one better than another, depending on the flavoring and the artificial sweetener. Often the ideal option is to try an unflavored formula first, although many older individuals find these harder to drink in large volumes throughout the day. For those individuals some EoE centers or clinics will suggest a feeding tube, at least in the beginning. Neocate Splash, Unflavored is the newest unflavored elemental formula and some folks prefer the taste of this to powders, since it has a different taste, and it’s also ideal for tube feedings.
      You also mentioned that there was little relief after 2 weeks? For some patients, a longer trial is needed to see the full benefit. Many EoE teams will wait 6 to 8 weeks before they assess whether an intervention has been successful. The best thing to do is to talk with the healthcare team - the more members of the team the better - to see what options you have.
      Best of luck,

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Food Allergy Living is a resource for parents of children with food allergies, brought to you by Nutricia, the makers of Neocate. For more in-depth information about our purpose & authors, see our About Food Allergy Living page.