Development of a Practical Guide to Implement and Monitor Diet Therapy for Eosinophilic Esophagitis

Abstract

Dietary therapy for short- and long-term management of eosinophilic esophagitis is an effective yet poorly understood and underutilized treatment strategy. Despite several prospective trials demonstrating the efficacy of dietary therapies, successful clinical implementation is hampered by the need for a multidisciplinary approach including dietitian support and provider expertise. The availability of these resources is not readily available to most gastroenterologists. Without standardized guidance on starting or completing the diet for gastrointestinal providers and/or consulting dietitians, provider attitudes toward dietary therapy vary greatly depending on familiarity and knowledge gaps in using diet therapy. This review aims to summarize evidence in support of dietary therapy in eosinophilic esophagitis while providing guidance on initiation and implementation of dietary therapy for providers.

Keywords: Elimination Diet; Eosinophil; Esophagus; Food Allergen; Food Reintroduction; Nutrition.

Figure 1.

Overall dietary strategy *Response defined by reduced esophageal eosinophilia < 15 eos/hpf, provided endoscopic and symptom improvement is also noted.

Figure 2.

Step up dietary strategy *Response defined by reduced esophageal eosinophilia < 15 eos/hpf, provided endoscopic and symptom improvement is also noted. If response is attained, then pursue reintroduction to further delineate food triggers.

Figure 3.

Proposed reintroduction order *Reintroduction order of soy and egg may be interchangeable. Reintroduction order of food groups can be modified based on preference, but this proposed order yields the quickest and most efficient reintroduction process.