Dietary Strategies in Adult Patients with Eosinophilic Esophagitis: A State-of-the-Art Review

Abstract

Allergen-free diets are a specific and effective anti-inflammatory therapy for eosinophilic esophagitis. They should be carried out by a multidisciplinary team to reduce side effects and improve adherence. According to recent guidelines and expert opinions, empirical diets with a reduced number of eliminated food categories and a step-up approach are the most encouraged strategy to reduce the number of endoscopies to identify food trigger(s) and maximize clinical results and adherence. Despite the fact that allergy testing-based diets are not recommended at a population level, geographical sensitization patterns may play a role in some patients in specific areas, such as in Southern and Central Europe.

Keywords: LTP; allergy; eosinophils.

Figure 1

Dietary therapies in eosinophilic oesophagitis should be carried out by a multidisciplinary team comprising, among others, an allergist, a gastroenterologist, a dietitian and a psychologist. The interaction between these professionals is suggested by the circle. The interaction between the allergist for adults and a paediatrician is especially important in the transition age.

Figure 2

Allergen-free diets have both a diagnostic and therapeutic role. A step-up to food elimination is depicted, from 2 to 6 food and to elemental diets in case of no response. After obtaining histological remission, a single food reintroduction at a time followed by endoscopy is needed to identify the trigger(s). Adapted from [9].

Figure 3

Maximal response rate for the different dietary strategies, including elemental diets, empirical diets and allergen-testing-based ones, according to the available literature on the matter.