What is a suitable dietary plan for managing ileitis in a patient with a history of eosinophilic (a condition characterized by an elevated number of eosinophils, a type of white blood cell) ileitis?

From the Guidelines

A food plan for managing ileitis in a patient with eosinophilic ileitis should prioritize a step-up approach to dietary management, starting with a 2-food exclusion diet for at least 8-12 weeks, as recommended by the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition 1. To manage ileitis in a patient with a history of eosinophilic ileitis, it is essential to consider the potential triggers of the condition. The step-up approach involves:

• Starting with a 2-food exclusion diet, excluding common trigger foods such as milk and wheat, for at least 8-12 weeks
• If histological remission is not achieved, proceeding to a 4-food exclusion diet, adding egg and soy to the excluded foods, for at least 8-12 weeks
• If still not in remission, considering a 6-food exclusion diet, also excluding fish/shellfish and tree nuts/peanuts, for at least 8-12 weeks This approach allows for the identification of specific trigger foods while minimizing the risk of nutritional deficiencies. Key considerations in the dietary management of eosinophilic ileitis include:
• Ensuring adequate nutrition and hydration throughout the elimination and reintroduction process
• Working with an experienced dietitian to structure the eating plan and avoid vitamin deficiencies
• Monitoring symptoms and adjusting the diet as needed based on symptom response
• Considering the potential risks of nutritional inadequacy, feeding difficulties, and impaired growth in children, and weight loss in adults, associated with elimination diets 1. It is crucial to balance the potential benefits of dietary management with the patient's health-related quality of life, taking into account the restrictiveness of the diet and the potential impact on eating behavior and long-term adherence to the treatment plan 1.

From the Research

Food Plan to Manage Ileitis for Patient with History of Eosinophilic Ileitis

To manage ileitis for a patient with a history of eosinophilic ileitis, the following food plan can be considered:

• Elemental diet: This diet has been shown to be effective in reducing inflammation and improving symptoms in patients with eosinophilic esophagitis 2, and may also be beneficial for patients with eosinophilic ileitis.
• Empiric elimination diets: These diets involve the elimination of common food allergens, such as milk, eggs, wheat, soy, fish, and nuts, and have been shown to be effective in inducing remission in patients with eosinophilic esophagitis 3, 4.
• Six-food elimination diet: This diet involves the elimination of six common food allergens (milk, eggs, wheat, soy, fish, and nuts) and has been shown to be effective in inducing remission in patients with eosinophilic esophagitis 3.
• Four-food elimination diet: This diet involves the elimination of four common food allergens (milk, eggs, wheat, and soy) and has been shown to be effective in inducing remission in patients with eosinophilic esophagitis 3.
• Two-food elimination diet: This diet involves the elimination of two common food allergens (milk and eggs) and has been shown to be effective in inducing remission in patients with eosinophilic esophagitis 3.

Considerations for Implementing a Food Plan

When implementing a food plan to manage ileitis for a patient with a history of eosinophilic ileitis, the following considerations should be taken into account:

• Patient demographics: The patient's age, sex, and medical history should be considered when selecting a food plan 3, 4.
• Nutritional status: The patient's nutritional status should be assessed and considered when selecting a food plan 3, 4.
• Social and financial support: The patient's social and financial support should be considered when selecting a food plan, as some diets may be more expensive or require more support than others 3, 4.
• Acceptance of repeated endoscopies: The patient's acceptance of repeated endoscopies should be considered when selecting a food plan, as some diets may require more frequent endoscopies than others 3, 4.

Potential Benefits and Challenges of Elemental Diets

Elemental diets have been shown to be effective in reducing inflammation and improving symptoms in patients with eosinophilic esophagitis 2, and may also be beneficial for patients with eosinophilic ileitis. However, elemental diets can be challenging to implement and maintain, due to their poor palatability and high cost 5. Additionally, elemental diets may not be suitable for all patients, particularly those with restrictive food intake disorders 5.