Eliminating dairy can help treat eosinophilic esophagitis

Dear Dr. Roach: After reading your column on difficulty swallowing, I wanted to write in about my experience with dysphagia. An endoscopy with dilation and biopsies confirmed that I had eosinophilic esophagitis. My gastroenterologist suggested a one-food elimination diet. I am allergic to the protein in milk, so no dairy products for me! It’s only been four months since my last endoscopy, but I have not experienced difficulty swallowing. In addition to eliminating all dairy products, I’m still very careful about how I eat.

P.R.

Eosinophilic esophagitis is an immune-mediated disease of the esophagus. Swallowing difficulty, especially with solid foods, and symptoms of heartburn that don’t get better with the standard treatments are the hallmark symptoms of this unusual condition.

Your gastroenterologist is on top of the literature. A study from 2023 showed that a diet eliminating all cow’s milk products was just as effective at controlling the disease as a much more onerous elimination diet of six foods. This is strong evidence that eosinophilic esophagitis is caused by food allergies/sensitivities, in at least a large number of people.

Some people with eosinophilic esophagitis may still need medical therapy, and those who have developed strictures in their esophagus may need treatment. But food elimination diets, usually starting with cow’s milk products, is an effective first-line treatment for many. Thanks for writing!

Dear Dr. Roach: I am a 75-yearold man who has just been diagnosed with trigeminal neuralgia (TN) in the left side of my face. Is there a treatment for this condition, except being on medicine for the rest of my life?

P.H.

The trigeminal nerve is responsible for the motor and sensory innervation to the face. It is called trigeminal because of its three divisions: V1 to the forehead; V2 to the upper jaw; and V3 to the lower jaw and ears. TN is most often caused by the compression of the root of the nerve, usually deep in the brain. The compression is most often caused by a blood vessel, but it can be caused by a tumour or another structure.

TN is sometimes misdiagnosed as dental pain, and other conditions (such as neuropathy after shingles) can be misdiagnosed as TN. But an experienced neurologist or pain management specialist can usually make the diagnosis through a careful history review and physical exam. An MRI is usually obtained to find the location of the nerve compression.

Although the pain of TN is usually described as sharp and sudden with brief paroxysms of pain, some people have continuous pain or other types of pain patterns. Medications are the usual first-line treatment for TN, and some people do very well with treatment. The pain of TN can come and go, with remissions lasting for months or later. Anti-epilepsy and antidepressant drugs are most often used.

When medications are ineffective, surgical and radiation treatment can be considered, although it has its own risks, which is why it is not the firstline treatment. Unfortunately, surgical relief may also not be long-lasting.