Diet therapy for eosinophilic esophagitis: When, why and how

PURPOSE OF REVIEW: With the increasing recognition of eosinophilic esophagitis (EoE) over the past two decades, pharmacologic and dietary therapies have emerged as primary management options. The effectiveness of the elimination dietary therapy supports the conceptual definition of EoE as an antigen/immune-mediated esophageal disease. This manuscript reviews the three types of dietary therapy: an elemental formula diet with complete elimination of table foods, an allergy testing-directed elimination diet and an empiric elimination diet based on common food allergens. RECENT FINDINGS: Recent prospective studies have demonstrated symptomatic and histologic response to an elimination diet in adults with EoE that is comparable with response rates previously reported in children. Retrospective, comparative data in pediatric EoE have identified the elemental diet as offering the greatest likelihood of histologic disease remission compared with either allergy testing-directed or empiric elimination diets. The long-term goal of each dietary approach is the eventual identification of a single or limited number of trigger foods, thereby allowing a return to as regular a diet as possible. SUMMARY: Studies continue to support dietary therapy as an important and effective therapy for EoE. Although topical steroids continue to be a mainstay of therapy, none are presently Food and Drug Administration-approved for EoE. In addition, many patients are reluctant to utilize pharmacologic therapy on a chronic basis. Further research is necessary to better understand and optimize the use of diet therapy for EoE.