Lesley Stanford MS, RD, CSP Pediatric Nutritionist EoE Nutrition & Diet Lesley Stanford MS, RD, CSP Pediatric Nutritionist

Below is an excerpt from a letter written by James D Below is an excerpt from a letter written by James D., a 4th grader in Birmingham, Alabama who describes the decision to eliminate all foods: “Before I went off all food I was throwing up every day.  I was sick.  I felt like I had the flu every second of the day.  There was chest pain that felt like a baseball hitting it when I ate anything.  My stomach felt cramped.  I also felt too sick to participate in life.  I still felt that way when I tried steroid treatment and elimination diet. “I helped make the decision to go off all food because l felt so bad.   My doctor offered for me too drink the formula, but I couldn’t.  I tried a NG tube and couldn’t stop throwing up, so I got a G tube and did not throw up anymore.  All of my symptoms disappeared after I stopped eating food.  I felt better and life was better because there was no pain. “I am thankful for my mom, dad, and doctors for helping me feel better.  I thank them for believing in me and encouraging me.  Today I feel that my EoE is getting less prominent in my life now that my foods list is so much bigger from trialing foods.” from www.APFED.com

Diet as Treatment Elemental diet‐ An exclusive amino acid based formulation SFED‐ Exclusion of selected foods: cow’s milk, wheat, egg, soy, peanuts/tree‐nuts and fish/shellfish 4‐FED‐ Exclusion of the four most common trigger foods of EoE: cow’s milk, wheat, egg and soy Milk Elimination‐ Exclusion of the most common trigger food of EoE: cow’s milk

Elemental Diet Difficult to follow Research published in the American Journal of Gastroenterology and Clinical Gastroenterology and Hepatology has shown the majority of children (95-98%) got better on the elemental diet (less symptoms). Patients stay on the elemental diet for approximately six weeks. If a repeat endoscopy shows that the esophagus has healed, food can be reintroduced.

Elemental Diet: Infant Alfamino Elecare Neocate PurAmino All are 20 kcal/ounce as standard dilution, powdered, protein source of free amino acids

Elemental Diet: Pediatric Alfamino Junior Elecare Junior Neocate Junior E028 Splash Neocate Splash, unflavored All are 30 calories per ounce, 33-65% of fat is MCT. Some powdered, some ready to feed

Elemental Diet If a child is is growing poorly and it will likely slow healing and negatively affect growth and development, the child may need a feeding tube. Difficulty swallowing, refusal to take the prescribed diet or inability to drink enough formula are common reasons for supplemental feeding tubes. May recommend a NG tube or g-tube placement.

Are foods allowed while on the elemental diet? Pure cane sugar and candies made with pure sugar such as, lollipops and Smarties Cherry and grape powdered Kool-aid and Kool-aid Jammers, Gatorade Salt, baking soda, ascorbic acid, corn syrup, highly refined oils and artificial sweeteners. The child’s doctor or dietitian can provide families with information on acceptable foods or additives the child can have along with formula.

Diet Histories Diet histories can help the doctor or dietitian. Some ways to collect a Diet History are Food Frequency Questionnaires, a 24 Hour Recall, or a Food Diary, which is also called a Food Record.  Food diaries/records provide a lot of detail, so they are commonly used to take a diet history from someone who has food allergies.

SFED These foods are: Milk Egg Wheat Soy Fish and shellfish Peanuts and Tree nuts

Cocoa Crunch Bars 6 cups rice or corn (GF) cereal Melt the butter alternative over low heat and stir in marshmallows 1 bag marshmallows Add cocoa powder and chocolate chips until melted 1/4 cup DF/SF butter alternative 1/4 cup cocoa powder Slowly mix cereal until bowl 1 cup DF/SF/TN/PN free chocolate chips Sprinkle a few chocolate chips on top Directions: From Raquel Durban, RD