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Dig Dis Sci. 2019 Mar 29. doi: 10.1007/s10620-019-05602-w. [Epub ahead of print]

Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis.

Author information

1
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, UNC-CH, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA.
2
Asthma and Allergy Specialists, PA, Charlotte, NC, USA.
3
Food Allergy Institute of Charlotte, Charlotte, NC, USA.
4
Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, UNC-CH, CB#7080, Bioinformatics Building, 130 Mason Farm Rd., Chapel Hill, NC, 27599-7080, USA. edellon@med.unc.edu.

Abstract

Eosinophilic esophagitis (EoE) is an immune-mediated disease triggered by food antigens for which dietary elimination treatment can induce and sustain histologic remission. Our review aims to describe the state of the art regarding dietary treatment of EoE, highlighting a number of areas of controversy related to dietary therapy in EoE, including novel modalities for determining food triggers, making the empiric dietary elimination process more efficient, issues of cross-contamination and "dosing" of how much food to avoid or add back, costs and effects on quality of life, long-term efficacy, and the risk of developing immediate IgE-type reactions after initial dietary elimination. Elemental formulas, empiric elimination diets, and targeted allergy test-directed elimination diets are well-described treatments for EoE. Although elemental diets are most efficacious, their clinical use is limited by cost and the palatability of an exclusively liquid diet. While empiric elimination is less effective than elemental formula-based diets, they are more easily implemented and often sustainable. Since the comparative effectiveness of elimination diets with proton-pump inhibitors and swallowed topical steroids remains unknown, there are multiple areas to address with future research.

KEYWORDS:

Allergy; Diet; Eosinophilic esophagitis; Food elimination; Treatment

PMID:
30927211
DOI:
10.1007/s10620-019-05602-w

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