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Minerva Gastroenterologica e Dietologica 2020 June;66(2):124-35

DOI: 10.23736/S1121-421X.19.02634-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Treatment of eosinophilic esophagitis with diets

Alfredo J. LUCENDO 1, 2, 3 , Javier MOLINA-INFANTE 2, 4

1 Department of Gastroenterology, Tomelloso General Hospital, Tomelloso, Spain; 2 Biomedical Research Network Center for Liver and Digestive Diseases (CIBERehd), Madrid, Spain; 3 Research Institute, La Princesa Hospital, Madrid, Spain; 4 Department of Gastroenterology, San Pedro de Alcántara University Hospital, Cáceres, Spain



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.


KEY WORDS: Eosinophilic esophagitis; Food hypersensitivity; Diet therapy; Formulated food

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