Dietary Management of Eosinophilic Esophagitis in Patients on a Ketogenic Diet for Refractory Epilepsy: A Retrospective Clinician Reported Case Series.

BACKGROUND/

objectivesEosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus that is challenging to treat. Ketogenic diets (KD) are used in patients with refractory epilepsy due to its well-documented efficacy for seizure control. As more individuals with refractory epilepsy are maintained on KD, clinicians are increasingly identifying EoE in this population.

methodsThis is a retrospective clinician reported case series collected through a survey of registered dietitians who have managed a patient(s) on KD, who also had EoE, to describe what diet approaches were used. Data was collected on patient demographics, epilepsy diagnosis, feeding methods, diet prior to EoE diagnosis, endoscopy findings, EoE treatment, diet after EoE diagnosis, follow-up endoscopy results, and treatment response.

resultsNine unique cases were reported. In nearly all cases (except one), clinicians implemented dietary modifications following an EoE diagnosis alongside conventional medical therapies. The dietary strategies varied: three received an extensively hydrolyzed whey-based ketogenic formula via tube feeding, two were managed with plant-based ketogenic formulas, while one case each was placed on a complete amino acid protein plus modular ketogenic tube-fed diet, a low-dairy oral KD, and a nut-free oral KD. Only two encountered difficulties with the dietary modifications, whereas the majority reported noticeable improvements in gastrointestinal symptoms.

conclusionsThis study describes several dietary approaches used to address EoE in patients following a KD. Limitations include the small and retrospective nature of the study. Further research is needed to understand the long-term efficacy and pathophysiology of these dietary interventions in those with EoE.