Treatment Options for Eosinophilic Esophagitis: Elimination Diets and Beyond

• Published in: Current treatment options in gastroenterology Vol. 21; no. 2; pp. 204 - 217
• Main Authors: Strauss, Alexandra L., Hennessey, Lilly, Lynch, Kristle L.
• Format: Journal Article
• Language: English
• Published: New York Springer US 10-04-2023
• Subjects: Gastroenterology; Medicine; Medicine & Public Health; Topical Collection on Obesity and Nutrition; Adherence; Allergy; Elemental Diets; Diet; Step-up; Elimination Diets; Eosinophilic Esophagitis
• ISSN: 1534-309X; 1534-309X
• DOI: 10.1007/s11938-023-00416-2

Purpose of Review
Eosinophilic Esophagitis (EoE) is a chronic immune-mediated disease triggered by a complex interplay of allergens with the esophageal epithelium. Elimination diets are a well-established effective treatment option. This review provides details on both the established and novel evidence supporting dietary therapy. We also explore barriers to dietary implementation and long-term maintenance.
Recent Findings
Options for elimination diets in EoE include allergen-directed elimination, six-food elimination diet (SFED), four-food elimination diet (4FED), two-food elimination diet (2FED), step-up diet (2–4-6), one-food elimination diet (1FED), and elemental diets. A recent prospective study on 1FED with cow’s milk protein avoidance noted histologic remission in 51% of children, which offers a reasonable alternative to the “step down” approach of the SFED process. Recognition of psychiatric comorbidities such as avoid/restrictive food intake disorder, esophageal hypervigilance, and symptom-specific anxiety is increasingly important.
Summary
Diet remains an option for long-term treatment in motivated EoE patients, with comparable responses to swallowed corticosteroids or dupilumab. Dietitian involvement facilitates patient education and nutritional optimization. Long-term adherence to EoE therapies is suboptimal and maintenance of elimination diets remains an ongoing challenge.