Can individuals with Eosinophilic Esophagitis (EOE) consume alcohol?

Risks of Untreated EOE and Alcohol Consumption with EOE

Alcohol consumption should be avoided in patients with Eosinophilic Esophagitis (EOE) as it can exacerbate chest pain and other symptoms of the condition. 1

Risks of Untreated EOE

Untreated EOE can lead to several serious complications that affect morbidity, mortality, and quality of life:

Progressive Complications

• Food impaction: Occurs in 33-54% of adults with EOE 1
• Esophageal strictures: Develop due to chronic inflammation and fibrosis 1
• Narrow-caliber esophagus: Results from ongoing inflammation 1
• Esophageal perforation: A rare but serious complication that can occur during food impaction or endoscopy 1

Long-term Disease Progression

• Esophageal remodeling: Chronic inflammation leads to fibrosis and permanent structural changes 1
• Persistent dysphagia: Becomes increasingly difficult to manage as the disease progresses 1
• Reduced quality of life: Due to dietary restrictions, social limitations, and anxiety around eating 1

Alcohol and EOE

The British Society of Gastroenterology guidelines and other evidence indicate that alcohol should be avoided in EOE for several reasons:

Why Alcohol Should Be Avoided

1. Symptom Exacerbation: Alcohol can worsen chest pain, which is the second most common symptom in adults with EOE 1
2. Coping Mechanisms: Patients with EOE often develop coping mechanisms including "avoiding foods or liquids that exacerbate pain, such as highly textured or bulky foods, alcohol, or acidic drinks" 1
3. Esophageal Irritation: Alcohol can directly irritate the already inflamed esophageal mucosa 1
4. Barrier Function: Alcohol may compromise the esophageal epithelial barrier, which is already impaired in EOE 1

Management of EOE

For patients diagnosed with EOE, the following treatment approaches are recommended:

First-Line Treatments

1. Proton Pump Inhibitors (PPIs):

   • Recommended as first-line therapy with 8-12 weeks of treatment 1, 2
   • Response rates of approximately 41.7% compared to 13.3% with placebo 2

2. Topical Corticosteroids:

   • Swallowed fluticasone or budesonide 1, 2
   • Associated with histologic remission in 64.9% of patients compared to 13.3% for placebo 2

3. Dietary Therapy:

   • Six-food elimination diet (SFED) - removes milk, wheat, eggs, nuts, soy, fish/shellfish 1, 3
   • Elemental diet (amino acid-based formula) - highest efficacy but poor adherence 1
   • Food reintroduction identifies specific triggers - most commonly wheat (60%) and milk (50%) 3

Monitoring Response

• Endoscopy with biopsy is recommended 8-12 weeks after initiating treatment to assess histological response 1
• Clinical symptoms may not correlate with histological activity 1

Special Considerations

Pitfalls to Avoid

• Relying solely on symptoms: Histological inflammation can persist despite symptom improvement 1
• Overlooking PPI-responsive esophageal eosinophilia: Some patients respond to PPI therapy alone 1
• Neglecting persistent dysmotility: Some patients continue to have dysphagia despite histological remission due to underlying motility disorders 1

For Patients with Persistent Symptoms

• Consider high-resolution manometry to assess for dysmotility 1
• Endoscopic dilation may be necessary for patients with fibrostenotic disease 1, 2

Conclusion

Untreated EOE leads to progressive esophageal damage, including strictures, narrowing, and potential perforation. Alcohol consumption should be avoided as it can exacerbate symptoms, particularly chest pain. The management of EOE should focus on reducing inflammation through PPIs, topical corticosteroids, or dietary modifications, with regular monitoring of both symptoms and histological response.