Is Eosinophilic Esophagitis a Sugar SensitiveDisease?

Eosinophilic esophagitis is an inflammatory condition, causing dysphagia, food impaction and chest pain. A minimum of 15 eosinophils per high power field by esophageal biopsy is necessary for diagnosis. It has become an increasingly important cause of gastrointestinal morbidity in the past two decades. A 14 year old boy had received a diagnosis of eosinophilic esophagitis elsewhere at the age of 8 years. His medical history had been thought for many years to be psychosomatic until endoscopy was performed. The only other positive laboratory study was eosinophilia. In spite of conventional therapy, none of which improved overall symptoms, esophagitis persisted and he had failed to gain weight and stature. Physical examination revealed many indications of autonomic dysfunction and an erythrocyte transketolase test indicated abnormal thiamine homeostasis. Treatment was started with intravenous infusions of water-soluble vitamins that included thiamine hydrochloride (THCL). Because the transketolase test became worse, THCL was replaced with thiamine tetrahydrofurfuryl disulfide (TTFD), with consequent improvement in transketolase and symptomatic response. There was a family history of alcoholism and the patient was addicted to sugar, suggesting a genetic risk to explain the abnormal thiamine homeostasis. Beriberi causes dysautonomia in its early stages. Inflammation is now known to be suppressed reflexly through the vagus nerve, itself dependent on acetylcholine. Abnormal motility of the esophagus has been reported in eosinophilic esophagitis. Failure of THCL to improve transketolase activity suggested a genetic failure in a thiamine transporter and its consequent correction with TTFD that does not require the thiamine transport system.