Treatment of eosinophilic esophagitis with diets.
Study Goal
The researchers aimed to evaluate the role of dairy as a common food trigger in eosinophilic esophagitis (EoE) and the efficacy of elimination diets, including dairy, in managing the condition.
Results Summary
The study found that dairy is one of the most common food triggers for EoE, particularly in patients from the United States, Spain, and Australia. Elimination diets that exclude dairy, such as the 6-food, 4-food, and 2-food elimination diets, showed good efficacy rates in managing EoE symptoms.
Population
Pediatric and adult patients with eosinophilic esophagitis (EoE).
Effective Dosage
Not specified (elimination diets involved complete avoidance of dairy).
Duration
6 weeks for empiric 6-food elimination diet; duration for other diets not specified.
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
Elemental diets consisting in exclusively feeding patients with amino acid-based formulas | increase | efficacy rates | patients with EoE | best | have consistently shown the best efficacy rates | #1 |
Empiric 6-food elimination diets (withdrawing milk, wheat, egg, soy, nuts, and fish/seafood for 6 weeks) | increase | efficacy rates | patients with EoE | best | have consistently shown the best efficacy rates | #2 |
6-food elimination diets | increase | food triggers | patients with EoE | most common | have been instrumental to decipher the most common food triggers | #3 |
4-food elimination diet (dairy, wheat/gluten cereals, egg, and legumes) | increase | efficacy rates | - | good | were lately developed with good efficacy rates | #4 |
2-food elimination diet (dairy and milk/gluten) | increase | efficacy rates | - | good | were lately developed with good efficacy rates | #5 |
A step-up strategy (2-4-6) | increase | patient uptake | - | - | may enhance patient uptake | #6 |
A step-up strategy (2-4-6) | increase | responders to empiric diets | - | most | may ... promptly identify most responders to empiric diets with few food triggers | #7 |
Eosinophilic esophagitis (EoE) is a chronic inflammatory esophageal disease triggered and maintained predominantly by food antigens. It represents a unique form of non-IgE mediated food allergy, largely dependent upon delayed, cell-mediated hypersensitivity. First-line therapies for EoE consist on drugs with anti-inflammatory effect (mainly including topic steroids and proton pump inhibitors) and dietary therapy. An elimination diet that avoids the consumption of food triggers currently remains the only therapy targeting the cause of EoE. Currently, available food allergy tests are suboptimal to predict food triggers for EoE, especially in adult patients. Elemental diets consisting in exclusively feeding patients with amino acid-based formulas and empiric 6-food elimination diets (withdrawing milk, wheat, egg, soy, nuts, and fish/seafood for 6 weeks) have consistently shown the best efficacy rates. However, their high level of restriction and the need for multiple endoscopies have hampered their implementation in clinical practice. In contrast, studies on 6-food elimination diets have been instrumental to decipher the most common food triggers in patients with EoE, being milk, wheat/gluten, and egg involved in most of patients from the United States, Spain, and Australia. Hence less restrictive empiric schemes, such as a 4-food elimination diet (dairy, wheat/gluten cereals, egg, and legumes) or a 2-food elimination diet (dairy and milk/gluten) were lately developed with good efficacy rates. A step-up strategy (2-4-6) may enhance patient uptake and promptly identify most responders to empiric diets with few food triggers This review updates the most relevant advances on dietary therapy for pediatric and adult patients with EoE.