Dietary Management of Patients with Eosinophilic Esophagitis

Abstract

Twenty years after it was first described, eosinophilic esophagitis (EoE) is now recognized as a prevalent disorder, representing the second most common cause of chronic esophagitis (after gastroesophageal reflux) and constituting the main cause of esophageal symptoms in young patients. In most cases the disease is triggered and maintained by exposure to food antigens, thus representing a novel form of food allergy. While topical steroids still constitute the prevailing therapeutic option, there is increased interest in dietary therapy as a treatment alternative capable of inducing and maintaining drug-free remission of the disease. First assessed in a pediatric series, more recent studies have demonstrated that dietary therapy is equally effective for adult sufferers of EoE. Indeed, various types of dietary interventions that either eliminate or reduce food antigens from the diet have been shown to induce remission of esophageal inflammation and its derived symptoms in a high proportion of patients. After remission has been achieved, food reintroduction is an essential part of the dietary management of EoE and should always be considered once esophageal biopsies are normal. Food reintroduction consists of a food allergy challenge that facilitates the identification of specific food triggers for the disease. This allows patients to follow as normal a diet as possible, thus improving the acceptance of and adherence to specific dietary restrictions.The dietary management of EoE is a challenging therapy that should be considered for every patient with the disease. Its major limitations arise from the necessity of repeated endoscopies with biopsies during the food reintroduction protocol, as well as from the absence of noninvasive subrogated markers of disease activity. For these reasons, the use of dietary therapy has been limited to highly motivated patients who are reluctant to utilize drug-based therapies on a chronic basis, as well as to highly motivated health-care providers.Ongoing research on less restrictive dietary options should facilitate the spread of dietary interventions, making this type of therapy more available for extended use.