Personalising the dietary investigation and management of eosinophilic oesophagitis

Eosinophilic Oesophagitis (EoE) is a chronic condition, characterised by oesophageal symptoms and eosinophil predominant inflammation ≥15 eosinophils/high powered field (HPF). Increased understanding of disease pathogenesis in the past decade has suggested that EoE is primarily non-IgE mediated. However, dietary management strategies remain focused on elimination of common IgE-mediated food allergens and exploration of other adverse food reactions such as food chemical intolerances in these patients is limited. In addition, current dietary elimination strategies are ad hoc in nature and focus on the initial elimination phase and forgo explanation of the critical challenge/reintroduction and long term management of these patients. Thus, application of optimal dietary management in the clinical setting is difficult for the patient, dietitian and multidisciplinary team. This thesis aimed to inform dietary management, from assessment through to monitoring and evaluation of EoE, by exploring patient experiences and characteristics, and examining the use of a low chemical elimination diet and challenge protocol to develop a personalised dietary management approach, as well as exploring dietitian proficiency in managing the condition. The Nutrition Care Process (NCP) model was used as a framework for identification of key considerations for dietetic management.