Most people have experienced taking too big of a bite of food and having that lump of food feel as though it gets stuck in their throat as they swallow. This trouble with swallowing - known as dysphagia - can often be resolved with a quick cough or a large swig of water. For those struggling with Eosinophilic Esophagitis (EoE), trouble swallowing can be a daily struggle, and coughing or sipping water may not immediately alleviate their symptoms.
Eosinophilic esophagitis is an immune-based disorder that impacts the esophageal tissue. It affects 1 in 2000 people each year. Thankfully, a functional medicine approach to eosinophilic esophagitis, including dietary changes, medications, supplements, and more, can effectively relieve symptoms.
What is Eosinophilic Esophagitis?
Eosinophilic Esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus, characterized by the infiltration of eosinophils (a type of white blood cell) into the esophageal tissue. In EoE, there is so much immune activity in the esophagus that the esophagus becomes inflamed, irritated, leaky, and can even rupture, leading to excessive bleeding if left untreated for many years. This condition impacts the esophagus' ability to help with swallowing foods and liquids, and people who have it frequently experience issues with swallowing and throat or chest pain. Trouble swallowing can become so severe in EoE that people can choke or develop food impactions, which are medical emergencies.
What Causes Eosinophilic Esophagitis?
Eosinophilic Esophagitis (EoE) is a chronic, immune-mediated disorder of the esophagus. It's unclear what triggers the immune system in EoE. However, it is known that a combination of food allergies and sensitivities, mast cell degranulation, genetic predisposition, and environmental exposures can contribute to it.
Specifically, disordered TH2 immunity appears to be at the root of EoE. Increased numbers of T cells are found in the esophageal mucosa of people with EoE, as are increased levels of interleukins and tumor necrosis factor-alpha (TNF-α). People with EoE are more likely than others to have close family members with autoimmune disorders.
Additionally, IgG4 food reactions are highly involved in EoE symptoms. Removing specific foods that trigger IgG4 reactions or the top 4 foods most commonly involved in EoE reactions (dairy, wheat, eggs, soy) can alleviate symptoms and even improve tissue health on endoscopy.
Finally, changes to the microbiome are common in people with EoE, including small intestinal bacterial overgrowth (SIBO).
Eosinophilic Esophagitis Signs & Symptoms
The esophagus is responsible for transporting boluses of mechanically digested foods into the stomach. The esophagus has two sphincters – the upper esophageal sphincter, which opens and closes to allow food into the esophagus, and the lower esophageal sphincter (comprised partially of the diaphragm) that allows food from the esophagus into the stomach. EoE has symptoms associated with both the upper and lower sphincters. These symptoms can include:
- Difficulty swallowing (dysphagia)
- Chest pain
- Food getting stuck in the esophagus (food impaction)
- Abdominal pain
- Poor weight gain or weight loss
- Chronic coughing or wheezing
- Acid reflux
How to Test for Eosinophilic Esophagitis
- EoE is typically diagnosed via an endoscopic biopsy. During an endoscopy, a gastroenterologist will take and examine a sample of esophageal tissue under a microscope. When there are more than 15 eosinophils present per high power field or more than 60 eosinophils per mm squared in esophageal tissue, a diagnosis of EoE can be made.
- Barium swallows can also be diagnostic testing for EoE. During this test, an X-ray is taken from the chin to the chest to watch someone swallow a bolus of food containing a dye that will show up on the x-ray. During this test, people with EoE may exhibit esophageal narrowing, impaired swallowing, or strictures.
Finding the root cause of eosinophilic esophagitis includes testing beyond the diagnostic imaging/procedures listed above. Biomarkers that can be examined through blood work include:
- IgG4 antibodies to foods may trigger immune reactions in EoE.
- Elevated eosinophil protein X (EPX) in stool tests may be associated with increased eosinophil activity. EPX is a type of protein found in white blood cells.
- People with EoE tend to have altered levels of the following microbes in their gastrointestinal microbiomes, which can be picked up on a comprehensive digestive stool analysis test:
- H. Pylori
- People with EoE may also have SIBO, which can be diagnosed using a breath test.
How is Eosinophilic Esophagitis Treated?
Medical interventions which are often prescribed or completed by a medical doctor to alleviate the symptoms of EoE include
- Proton pump inhibitors (PPIs) - can prevent stomach acid from aggravating already inflamed tissue in the esophagus (PPIs can cause nutrient deficiencies, particularly of iron, calcium, and magnesium, as well as vitamin B12)
- Oral steroids - can be swallowed and may reduce inflammation in esophageal tissue
- Surgical dilation - to increase the amount of room in the esophagus to prevent choking
Dietary changes to improve EoE include the Step Up Diet and food elimination diets aimed at reducing the amount of immune-triggering foods a person ingests. A Step Up Diet typically consists of the following stages:
- Step 1: Remove dairy
- Repeat endoscopy in 6 weeks to assess for changes to the esophagus. If symptoms are improving, continue on the dairy-free diet. If there is no improvement, proceed to step 2.
- Step 2: Remove dairy and wheat
- Repeat endoscopy in 6 weeks to assess for changes to the esophagus. If symptoms are improving, continue. If there is no improvement, proceed to step 3.
- Step 3: Remove dairy, wheat, and eggs
- Repeat endoscopy in 6 weeks to assess for changes to the esophagus. If symptoms are improving, continue. If there is no improvement, proceed to step 4.
- Step 4: Remove dairy, wheat, eggs, and soy
- Repeat endoscopy in 6 weeks to assess for changes to the esophagus. If symptoms are improving, continue. If there is no improvement, proceed to step 5.
- Step 5: Remove corn, chicken, beef, and pork
- Repeat endoscopy in 6 weeks to assess for changes to the esophagus. If symptoms are improving, continue. If there is no improvement, proceed to step 6.
- Step 6: Remove peanuts, tree nuts, and seafood
- Repeat endoscopy in 6 weeks to assess for changes to the esophagus. If symptoms are improving, continue.
- If SIBO is present, a temporary low FODMAP diet can be used for short-term relief, while antimicrobial, prokinetic, and other treatments are used to address the root cause.
- Probiotics like lactobacillus and bifidobacterium, as well as short-chain fatty acids (probiotic products) like butyrate, have been shown to improve symptoms in people with EoE.
- Just as PPIs can help to improve outcomes in EoE, demulcent herbs can also be helpful to improve symptoms by helping to soothe irritation in esophageal tissues. These herbs include Althea officinalis (marshmallow), DGL (deglycyrrhizinated licorice root), and aloe vera.
- Mast cells are found in high concentrations in the esophageal tissue of people with EoE. When released, mast cells contain histamine, which can create tissue permeability (similar to leaky gut). Consumption or supplementation of vitamin C can act as a stabilizer for these side effects.
Eosinophilic esophagitis can impact swallowing and make life stressful for people who suffer from it. But, with the right team and interventions, it can be a smooth path to recovery. A functional medicine approach to eosinophilic esophagitis that includes pharmaceuticals, procedures, nutrition, herbs, supplements, microbiome support, and more can be highly successful in relieving symptoms so that you can thrive.
Lab Tests in This Article
- 10 Signs You Should Try An Elimination Diet. (2020). Rupahealth.com. https://www.rupahealth.com/post/how-to-do-an-elimination-diet
- Acharya, K. R., & Ackerman, S. J. (2014). Eosinophil Granule Proteins: Form and Function. Journal of Biological Chemistry, 289(25), 17406–17415. https://doi.org/10.1074/jbc.r113.546218
- Ahn, J., Ahn, H. S., Cheong, J. H., & dela Peña, I. (2016). Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy. Neural Plasticity, 2016, 1–18. https://doi.org/10.1155/2016/1320423
- Ali, A. A., Jadeja, S., Agrawal, N., Lamsal, S., Patel, S., & De Souza Ribeiro, B. (2021). Active bleeding from downhill varices: case report and management. VideoGIE. https://doi.org/10.1016/j.vgie.2021.03.008
- Anatomy of the Esophagus | SEER Training. (2022). Cancer.gov. https://training.seer.cancer.gov/ugi/anatomy/esophagus.html
- Approach to the evaluation of dysphagia in adults. (2022). Uptodate.com. https://www.uptodate.com/contents/approach-to-the-evaluation-of-dysphagia-in-adults?search=eosinophilic%20esophagitis&source=search_result&selectedTitle=8~150&usage_type=default&display_rank=8
- Arias, Á., Pérez-Martínez, I., Tenías, J. M., & Lucendo, A. J. (2015). Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Alimentary Pharmacology & Therapeutics, 43(1), 3–15. https://doi.org/10.1111/apt.13441
- Authier, H., Salon, M., Rahabi, M., Bertrand, B., Blondeau, C., Kuylle, S., Holowacz, S., & Coste, A. (2021). Oral Administration of Lactobacillus helveticus LA401 and Lactobacillus gasseri LA806 Combination Attenuates Oesophageal and Gastrointestinal Candidiasis and Consequent Gut Inflammation in Mice. Journal of Fungi, 7(1), 57. https://doi.org/10.3390/jof7010057
- Chung, K. F. (2015). Targeting the interleukin pathway in the treatment of asthma. The Lancet, 386(9998), 1086–1096. https://doi.org/10.1016/s0140-6736(15)00157-9
- Clayton, F., Fang, J. C., Gleich, G. J., Lucendo, A. J., Olalla, J. M., Vinson, L. A., Lowichik, A., Chen, X., Emerson, L., Cox, K., O’Gorman, M. A., & Peterson, K. A. (2014). Eosinophilic Esophagitis in Adults Is Associated With IgG4 and Not Mediated by IgE. Gastroenterology, 147(3), 602–609. https://doi.org/10.1053/j.gastro.2014.05.036
- Dellon, E. S. (2014). Epidemiology of Eosinophilic Esophagitis. Gastroenterology Clinics of North America, 43(2), 201–218. https://doi.org/10.1016/j.gtc.2014.02.002
- Dellon, E. S., Liacouras, C. A., Molina-Infante, J., Furuta, G. T., Spergel, J. M., Zevit, N., Spechler, S. J., Attwood, S. E., Straumann, A., Aceves, S. S., Alexander, J. A., Atkins, D., Arva, N. C., Blanchard, C., Bonis, P. A., Book, W. M., Capocelli, K. E., Chehade, M., Cheng, E., & Collins, M. H. (2018). Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology, 155(4), 1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009
- Demulcent. (2011, October 24). The Naturopathic Herbalist; The Naturopathic Herbalist. https://thenaturopathicherbalist.com/herbal-actions/b-d/demulcent-2/
- Di Pierro, F., Gatti, Rapacioli, G., & Ivaldi. (2013). Outcomes in patients with nonerosive reflux disease treated with a proton pump inhibitor and alginic acid ± glycyrrhetinic acid and anthocyanosides. Clinical and Experimental Gastroenterology, 27. https://doi.org/10.2147/ceg.s42512
- Egan, M., & Furuta, G. T. (2018). Eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis. Annals of Allergy, Asthma & Immunology, 121(2), 162–167. https://doi.org/10.1016/j.anai.2018.06.013
- Eosinophilic Esophagitis. (2020). Medlineplus.gov; National Library of Medicine. https://medlineplus.gov/eosinophilicesophagitis.html
- Eosinophilic Esophagitis. (2022, June 29). Hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/eosinophilic-esophagitis#:~:text=Eosinophilic%20esophagitis%20is%20an%20allergic,in%20reaction%20to%20an%20allergen.
- Eosinophilic esophagitis - Symptoms and causes. (2022). Mayo Clinic; https://www.mayoclinic.org/diseases-conditions/eosinophilic-esophagitis/symptoms-causes/syc-20372197
- Eosinophilic Esophagitis: Genetics and Immunopathologies. (2022). Uptodate.com. https://www.uptodate.com/contents/eosinophilic-esophagitis-eoe-genetics-and-immunopathogenesis?search=eosinophilic%20esophagitis&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4
- Esophageal Disorders: Types, Risks, Symptoms and Treatment. (2021). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/16976-esophageal-disorders#:~:text=The%20most%20common%20esophageal%20disorder,acid%20reflux)%2C%20causing%20inflammation.
- Esophagus - Knowledge @ AMBOSS. (2022). Amboss.com. https://www.amboss.com/us/knowledge/Esophagus
- Farhat, W., Chatelain, F., Marret, A., & Fuchs, A. (2021). Trends in 3D bioprinting for esophageal tissue repair and reconstruction. ResearchGate; Elsevier. https://www.researchgate.net/publication/344991969_Trends_in_3D_bioprinting_for_esophageal_tissue_repair_and_reconstruction
- Functional Dysphagia - Esophageal Health | UCLA Health. (2019). Uclahealth.org; UCLA Health. https://www.uclahealth.org/medical-services/gastro/esophageal-health/diseases-we-treat/dysphagia/functional-dysphagia#:~:text=What%20are%20functional%20esophageal%20disorders,gastroesophageal%20reflux%20disease%20(GERD).
- Gill, P. A., Inniss, S., Kumagai, T., Rahman, F. Z., & Smith, A. M. (2022). The Role of Diet and Gut Microbiota in Regulating Gastrointestinal and Inflammatory Disease. Frontiers in Immunology, 13. https://doi.org/10.3389/fimmu.2022.866059
- Hannan, N., Steel, A., McMillan, S. S., & Tiralongo, E. (2020). Health Service Use and Treatment Choices for Pediatric Eosinophilic Esophagitis: Findings From a Cross-Sectional Survey of Australian Carers. Frontiers in Pediatrics, 8. https://doi.org/10.3389/fped.2020.00147
- Harris, J. K., Fang, R., Wagner, B. D., Choe, H. N., Kelly, C. J., Schroeder, S., Moore, W., Stevens, M. J., Yeckes, A., Amsden, K., Kagalwalla, A. F., Zalewski, A., Hirano, I., Gonsalves, N., Henry, L. N., Masterson, J. C., Robertson, C. E., Leung, D. Y., Pace, N. R., & Ackerman, S. J. (2015). Esophageal Microbiome in Eosinophilic Esophagitis. PLOS ONE, 10(5), e0128346. https://doi.org/10.1371/journal.pone.0128346
- Health, U. (2021). Eosinophilic esophagitis (EoE): Approaching from all angles [YouTube Video]. In YouTube. https://www.youtube.com/watch?v=DHzMnnMuFp0
- Heidelbaugh, J. J. (2013). Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Therapeutic Advances in Drug Safety, 4(3), 125–133. https://doi.org/10.1177/2042098613482484
- Heine, R. G., Peters, R., Cameron, D. J., Alex, G., Oliver, M. R., Hardikar, W., Chow, C. W., McWilliam, V. L., Moore, D. J., Kakakios, A. M., Cheah, E., O’Loughlin, E. V., Axelrad, C., & Allen, K. (2019). Effect of a 4-Food Elimination Diet and Omeprazole in Children with Eosinophilic Esophagitis – A Randomized, Controlled Trial. Journal of Allergy and Clinical Immunology, 143(2), AB309. https://doi.org/10.1016/j.jaci.2018.12.941
- Huss, M., Völp, A., & Stauss-Grabo, M. (2010). Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems - an observational cohort study. Lipids in Health and Disease, 9(1), 105. https://doi.org/10.1186/1476-511x-9-105
- Inage, E., Furuta, G. T., Menard-Katcher, C., & Masterson, J. C. (2018). Eosinophilic esophagitis: pathophysiology and its clinical implications. American Journal of Physiology-Gastrointestinal and Liver Physiology, 315(5), G879–G886. https://doi.org/10.1152/ajpgi.00174.2018
- Jensen, E. T., & Dellon, E. S. (2018). Environmental factors and eosinophilic esophagitis. Journal of Allergy and Clinical Immunology, 142(1), 32–40. https://doi.org/10.1016/j.jaci.2018.04.015
- Jensen, E. T., Kappelman, M. D., Kim, H. P., Ringel-Kulka, T., & Dellon, E. S. (2013). Early Life Exposures as Risk Factors for Pediatric Eosinophilic Esophagitis. Journal of Pediatric Gastroenterology & Nutrition, 57(1), 67–71. https://doi.org/10.1097/mpg.0b013e318290d15a
- Kleuskens, M. T. A., Haasnoot, M. L., Herpers, B. M., Ampting, M. T. J. van, Bredenoord, A. J., Garssen, J., Redegeld, F. A., & van Esch, B. C. A. M. (2021). Butyrate and propionate restore interleukin 13‐compromised esophageal epithelial barrier function. Allergy, 77(5), 1510–1521. https://doi.org/10.1111/all.15069
- Klion, A. (2017). Recent advances in understanding eosinophil biology. F1000Research, 6, 1084. https://doi.org/10.12688/f1000research.11133.1
- Kristle Lee Lynch. (2022, March 4). Eosinophilic Esophagitis. Merck Manuals Professional Edition; Merck Manuals. https://www.merckmanuals.com/en-ca/professional/gastrointestinal-disorders/esophageal-and-swallowing-disorders/eosinophilic-esophagitis
- Majamaa, Laine, & Miettinen. (1999). Eosinophil protein X and eosinophil cationic protein as indicators of intestinal inflammation in infants with atopic eczema and food allergy. Clinical & Experimental Allergy, 29(11), 1502–1506. https://doi.org/10.1046/j.1365-2222.1999.00666.x
- Mohiuddin, A. (2019). Alternative Treatments for Minor GI Ailments. INNOVATIONS in Pharmacy, 10(3), 2. https://doi.org/10.24926/iip.v10i3.1659
- Molina-Infante, J., Arias, Á., Alcedo, J., Garcia-Romero, R., Casabona-Frances, S., Prieto-Garcia, A., Modolell, I., Gonzalez-Cordero, P. L., Perez-Martinez, I., Martin-Lorente, J. L., Guarner-Argente, C., Masiques, M. L., Vila-Miravet, V., Garcia-Puig, R., Savarino, E., Sanchez-Vegazo, C. T., Santander, C., & Lucendo, A. J. (2018). Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study. Journal of Allergy and Clinical Immunology, 141(4), 1365–1372. https://doi.org/10.1016/j.jaci.2017.08.038
- Nobel, Y. R., Snider, E. J., Compres, G., Freedberg, D. E., Khiabanian, H., Lightdale, C. J., Toussaint, N. C., & Abrams, J. A. (2018). Increasing Dietary Fiber Intake Is Associated with a Distinct Esophageal Microbiome. Clinical and Translational Gastroenterology, 9(10), e199. https://doi.org/10.1038/s41424-018-0067-7
- Noel, R. J., Putnam, P. E., Collins, M. H., Assa’ad, A. H., Guajardo, J. R., Jameson, S. C., & Rothenberg, M. E. (2004). Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. Clinical Gastroenterology and Hepatology, 2(7), 568–575. https://doi.org/10.1016/s1542-3565(04)00240-x
- O’Shea, K. M., Aceves, S. S., Dellon, E. S., Gupta, S. K., Spergel, J. M., Furuta, G. T., & Rothenberg, M. E. (2018). Pathophysiology of Eosinophilic Esophagitis. Gastroenterology, 154(2), 333–345. https://doi.org/10.1053/j.gastro.2017.06.065
- Organs of the digestive system. (2022). Kenhub. https://www.kenhub.com/en/library/anatomy/stages-of-swallowing
- Peterson, K., Firszt, R., Fang, J., Wong, J., Smith, K. R., & Brady, K. A. (2016). Risk of Autoimmunity in EoE and Families: A Population-Based Cohort Study. American Journal of Gastroenterology, 111(7), 926–932. https://doi.org/10.1038/ajg.2016.185
- Proton pump inhibitors: MedlinePlus Medical Encyclopedia. (2016). Medlineplus.gov. https://medlineplus.gov/ency/patientinstructions/000381.htm
- Racca, F., Pellegatta, G., Cataldo, G., Vespa, E., Carlani, E., Pelaia, C., Paoletti, G., Messina, M. R., Nappi, E., Canonica, G. W., Repici, A., & Heffler, E. (2022). Type 2 Inflammation in Eosinophilic Esophagitis: From Pathophysiology to Therapeutic Targets. Frontiers in Physiology, 12. https://doi.org/10.3389/fphys.2021.815842
- Remedios, M., Campbell, C., Jones, D. M., & Kerlin, P. (2006). Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointestinal Endoscopy, 63(1), 3–12. https://doi.org/10.1016/j.gie.2005.07.049
- Roca, M., Donat, E., Rodriguez Varela, A., Carvajal, E., Cano, F., Armisen, A., Ekoff, H., Cañada-Martínez, A. J., Rydell, N., & Ribes-Koninckx, C. (2021). Fecal Calprotectin and Eosinophil-Derived Neurotoxin in Children with Non-IgE-Mediated Cow’s Milk Protein Allergy. Journal of Clinical Medicine, 10(8), 1595. https://doi.org/10.3390/jcm10081595
- Rycyk, A., Cudowska, B., & Lebensztejn, D. M. (2020). Eosinophil-Derived Neurotoxin, Tumor Necrosis Factor Alpha, and Calprotectin as Non-Invasive Biomarkers of Food Protein-Induced Allergic Proctocolitis in Infants. Journal of Clinical Medicine, 9(10), 3147. https://doi.org/10.3390/jcm9103147
- Schwab, D., Müller, S., Aigner, T., Neureiter, D., Kirchner, T., Hahn, E. G., & Raithel, M. (2003). Functional and Morphologic Characterization of Eosinophils in The Lower Intestinal Mucosa of Patients With Food Allergy. American Journal of Gastroenterology, 98(7), 1525–1534. https://doi.org/10.1111/j.1572-0241.2003.07484.x
- Schwab, D., Raithel, M., Klein, P., Winterkamp, S., Weidenhiller, M., Radespiel-Troeger, M., Hochberger, J., & Hahn, E. G. (2001). Immunoglobulin E and Eosinophilic Cationic Protein in Segmental Lavage Fluid of The Small and Large Bowel Identify Patients With Food Allergy. American Journal of Gastroenterology, 96(2), 508–514. https://doi.org/10.1111/j.1572-0241.2001.03467.x
- Shah, K., Ignacio, A., McCoy, K. D., & Harris, Nicola. L. (2020). The emerging roles of eosinophils in mucosal homeostasis. Mucosal Immunology, 13(4), 574–583. https://doi.org/10.1038/s41385-020-0281-y
- Simon, D., Cianferoni, A., Spergel, J. M., Aceves, S., Holbreich, M., Venter, C., Rothenberg, M. E., Terreehorst, I., Muraro, A., Lucendo, A. J., Schoepfer, A., Straumann, A., & Simon, H.-U. . (2016). Eosinophilic esophagitis is characterized by a non-IgE-mediated food hypersensitivity. Allergy, 71(5), 611–620. https://doi.org/10.1111/all.12846
- Soffer, G., Kaman, K., & Li, X.-M. (2020). Successful Management of Eosinophilic Esophagitis Using Traditional Chinese Medicine: A Case Report. The Yale Journal of Biology and Medicine, 93(5), 685–688. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7757072/
- Stone, K. D., Prussin, C., & Metcalfe, D. D. (2010). IgE, mast cells, basophils, and eosinophils. Journal of Allergy and Clinical Immunology, 125(2), S73–S80. https://doi.org/10.1016/j.jaci.2009.11.017
- UpToDate. (2022). Uptodate.com. https://www.uptodate.com/contents/society-guideline-links-eosinophilic-esophagitis?search=eosinophilic%20esophagitis&source=search_result&selectedTitle=6~150&usage_type=default&display_rank=6
- Votto, M., De Filippo, M., Lenti, M. V., Rossi, C. M., Di Sabatino, A., Marseglia, G. L., & Licari, A. (2022). Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach. Frontiers in Pediatrics, 9. https://doi.org/10.3389/fped.2021.820192
- Wechsler, M. E., Munitz, A., Ackerman, S. J., Drake, M. G., Jackson, D. J., Wardlaw, A. J., Dougan, S. K., Berdnikovs, S., Schleich, F., Matucci, A., Chanez, P., Prazma, C. M., Howarth, P., Weller, P. F., & Merkel, P. A. (2021). Eosinophils in Health and Disease: A State-of-the-Art Review. Mayo Clinic Proceedings, 96(10), 2694–2707. https://doi.org/10.1016/j.mayocp.2021.04.025
- Wilson, J. M., Li, R., & McGowan, E. C. (2020). The Role of Food Allergy in Eosinophilic Esophagitis. Journal of Asthma and Allergy, Volume 13, 679–688. https://doi.org/10.2147/jaa.s238565
- Wong, J., Goodine, S., Samela, K., Vance, K. S., Chatfield, B., Wang, Z., & Sayej, W. N. (2020a). Efficacy of Dairy Free Diet and 6-Food Elimination Diet as Initial Therapy for Pediatric Eosinophilic Esophagitis: A Retrospective Single-Center Study. Pediatric Gastroenterology, Hepatology & Nutrition, 23(1), 79. https://doi.org/10.5223/pghn.2020.23.1.79
- Wong, J., Goodine, S., Samela, K., Vance, K. S., Chatfield, B., Wang, Z., & Sayej, W. N. (2020b). Efficacy of Dairy Free Diet and 6-Food Elimination Diet as Initial Therapy for Pediatric Eosinophilic Esophagitis: A Retrospective Single-Center Study. Pediatric Gastroenterology, Hepatology & Nutrition, 23(1), 79. https://doi.org/10.5223/pghn.2020.23.1.79
- Wright, B. L., Kulis, M., Guo, R., Orgel, K. A., Wolf, W. A., Burks, A. W., Vickery, B. P., & Dellon, E. S. (2016). Food-specific IgG 4 is associated with eosinophilic esophagitis. Journal of Allergy and Clinical Immunology, 138(4), 1190-1192.e3. https://doi.org/10.1016/j.jaci.2016.02.024
- Yamada, Y. (2020). Unique features of non-IgE-mediated gastrointestinal food allergy during infancy in Japan. Current Opinion in Allergy & Clinical Immunology, 20(3), 299–304. https://doi.org/10.1097/aci.0000000000000642
- Yang, B.-G., Seoh, J.-Y., & Jang, M. H. (2017). Regulatory Eosinophils in Inflammation and Metabolic Disorders. Immune Network, 17(1), 41. https://doi.org/10.4110/in.2017.17.1.41
- Zhan, T., Ali, A., Choi, J. G., Lee, M., Leung, J., Dellon, E. S., Garber, J. J., & Hur, C. (2018). Model to Determine the Optimal Dietary Elimination Strategy for Treatment of Eosinophilic Esophagitis. Clinical Gastroenterology and Hepatology, 16(11), 1730-1737.e2. https://doi.org/10.1016/j.cgh.2018.04.013
- Zhang, S., Jiang, Q., Mu, X., Wang, Z., Liu, S., Yang, Z., Xu, M., Ren, X., & Wang, Y. (2020). A comparison of the efficacy and safety of complementary and alternative therapies for gastroesophageal reflux disease. Medicine, 99(30), e21318. https://doi.org/10.1097/md.0000000000021318
- Zukerberg, L., Mahadevan, K., Selig, M., & Deshpande, V. (2016). Oesophageal intrasquamous IgG4 deposits: an adjunctive marker to distinguish eosinophilic oesophagitis from reflux oesophagitis. Histopathology, 68(7), 968–976. https://doi.org/10.1111/his.12892
- (2020a). Rupahealth.com. https://www.rupahealth.com/post/an-integrative-medicine-approach-to-gerd
- (2020b). Rupahealth.com. https://www.rupahealth.com/post/a-functional-medicine-approach-to-acid-reflux