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Treatment of eosinophilic esophagitis with diets.

Minerva gastroenterologica e dietologica
June 1, 2020
Alfredo J Lucendo et al. (2 authors)
Journal ArticleReviewHuman Study
Study Details

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

Extracted Claims (7)
InterventionDirectionEndpointPopulationDosageImpactClaim #
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
Abstract

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.

Medical Subject Headings (MeSH)
Eosinophilic EsophagitisHumansHypersensitivity
Study Links
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality80/10
Citation Metrics
Total Citations8
Citations/Year1.6
Relative Citation Ratio0.69
NIH Percentile37%
Research Impact Scores
APT Score0.25
Weight Score2.27
Normalized Score0.64
Related Supplements
Treatment of eosinophilic esophagitis with diets. | Panacea Index