My gastroenterologist had a few treatments for me to try when he diagnosed me with EoE (eosinophilic esophagitis). I forget the exact order, but the elimination diet was definitely the last and it worked for me. Though, the first two medicine related treatments were much quicker and easier to try so they were worth trying first.
I tried a typical PPI (proton pump inhibitors) for a few weeks. Some people respond with a PPI, but it didn’t help me. At least this was cheap and easy to try.
I tried viscous budesonide, which is a thick liquid, compounded medicine. It did not help me. Typical places, such as CVS and Walgreens, do not produce this kind of medicine nowadays or at least not in my area. A local, independent pharmacy produced it for me. Unfortunately, the pharmacy is no longer in business.
Esophageal dilation is effective for improving symptoms 95% of the time. I had this procedure done twice. The first was dilating to 15mm and the second to 17mm. I think I had a very slight improvement, but nowhere enough for me to stop pursuing the next treatment.
When all else failed, it was time for an elimination diet, which excluded the six common areas of food allergies; wheat (all gluten containing food to be safe), dairy, nuts/peanuts, eggs, soy, and seafood/shellfish. This is a very long and difficult process, and a lot of planning is required. At first, all six foods were eliminated for six weeks. Then my swallowing finally improved towards the end of the six weeks and I added some time to make sure not a fluke occurrence. Then it came time to figure out what foods were causing the issue. I added a new food back every two weeks. A reaction may not happen immediately so that is why this is a slow process. Then when I had a reaction, I had to wait until I was well again so I could continue to the next food. It took us 166 days to tackle wheat/gluten, dairy, soy, eggs, and peanuts. I did not want to go any further and test out individual nuts and seafood. Ultimately, I discovered I had issues with wheat/gluten and dairy.
I will be honest: I failed at following through with the elimination diet two other times. The elimination of each food needs to be done to absolute perfection. If not, it will set you back or have inaccurate results. There are no shortcuts. I had a nutritionist help to fill in the gaps with my diet the first time I did it. Also worth noting, I had blood and skin prick allergy tests and none of them showed reactions to wheat. Those tests were done before trying treatments.
Once I discovered the precipitating foods, it has been much easier to live with EoE. Thankfully, my wife likes to cook and was able to adapt, which greatly helped with the process. Now I don’t even miss the foods that I cannot eat.