Dietary Approaches to Treating EoE: A Meta-Analysis

David A. Johnson, MD

Results were best with the elemental diet but strong and more generalizable with the less onerous six-food elimination diet.

Eosinophilic esophagitis (EoE) has been categorized as a food allergy because of evidence of disease remission with dietary elimination, which should be considered as an initial therapy in both children and adults with EoE (NEJM JW Gastroenterol Jun 7 2013). In choosing the optimal dietary intervention (elemental, empiric elimination, or targeted elimination) for patients, clinicians are currently hampered by variable findings on their effectiveness.

In a systematic review and meta-analysis, researchers evaluated the efficacy of dietary interventions to induce histologic remission in EoE (peak eosinophil counts <15 eosinophils per high-power field).

Results based on data from 23 articles and 10 abstracts were as follows:

• The overall efficacy for any dietary intervention was 66.3% (95% confidence interval, 56.9%–75.0%) and was similar in pediatric and adult patients. Diet-specific results are shown in the table.
• The efficacy of dietary treatment was higher in studies of high versus low quality (68.7% vs. 59.0%) and in studies published as articles versus abstracts (68.8% vs. 53.1%).
• Data were insufficient to analyze the efficacy of specific-food elimination diets (gluten, milk, and soy).
• No publication bias was identified.

Citation(s):

Arias Á et al. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: A systematic review and meta-analysis. Gastroenterology 2014 Jun; 146:1639.