Dietary Therapy in Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic inflammatory disease triggered by food antigens, characterized by TH2 cell and cytokine-mediated inflammation. Dietary therapy has emerged as a cornerstone in managing EoE. Elemental diets, while effective, pose challenges including nutritional deficits, adherence difficulty, and social limitations. Allergen-directed diets are less favored due to limited efficacy in predicting food triggers. Empiric elimination diets, like the six-food elimination diet, show promise but face adherence burdens and are cumbersome. Collaboration with dietitians is crucial for tailored nutrition assessment and support. Assessing response to dietary therapy involves standardized endoscopic and histological evaluation.

Less restrictive elimination diets (e.g., two-food elimination diet, 2–4-6 step-up diet, dairy-only elimination) offer promising alternatives with potentially fewer endoscopies. Emerging less invasive methods (e.g., esophageal string capsule test, Cytosponge, transnasal endoscopy) provide promising monitoring alternatives.

Dietary therapy is the primary non-pharmaceutical EoE treatment. Challenges persist, but newer, less restrictive approaches show promise. Implementation of dietary therapy requires careful consideration of patient factors and collaboration with dietitians to mitigate nutritional risks and ensure adherence. Less invasive monitoring methods offer alternatives, minimizing procedural burdens. Ongoing research aims to optimize strategies and improve patient outcomes.