Nutritional management of Eosinophilic Gastroenteropathies: Case series from the community

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. Symptoms of EoE in children can include abdominal pain, vomiting, coughing, and weight loss. The signs and symptoms of EoE can be similar to gastroesophageal reflux disease (GERD), thus making initial diagnosis difficult. Moreover, patients with EoE generally do not respond to GERD medications [2].One diagnostic criterion for EoE is an esophageal eosinophil count in excess of 15 eosinophils/HPF [2]. The esophagus normally should contain 0 eosinophils/HPF. The diagnosis of EC is more problematic since normal eosinophil counts in the colon vary depending on location. Less than 10 eosinophils/HPF is normal in the rectum, while a healthy cecum may contain more than 30 eosinophils/HPF [3].The ideal management of EoE is controversial. Traditionally, the swallowing of inhaled corticosteroids has been the preferred means of treatment [4]. More recently, promising research in this field suggests that nutritional management could be an effective strategy. There are generally two accepted nutritional approaches to treatment: the elemental diet and the elimination diet. Several case studies have found that in 98% of EoE patients treated with an elemental diet, symptoms and eosinophil counts decreased [4,5]. Elimination diets in which EoE patients avoid foods based on skin prick testing and atopy patch testing can result in resolution of EoE symptoms in 75% of patients [6-8].We report the use of nutritional management strategies to treat two children with EoE and one child with Eosinophilic Colitis.Patient A is a 5 year old girl who complained of abdominal pain for two years. She had been treated without any benefit with lansoprazole (a proton pump inhibitor) for reflux. A biopsy of the distal esophagus revealed greater than 20 eosinophils/HPF, confirming the diagn