The Efficacy of Dietary Elimination Strategies in Achieving Histological and Clinical Remission in Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic, Th2-mediated food antigen-driven inflammatory disease for which dietary elimination therapy is the only approach to treat the underlying etiology and the only approach that can provide long-term histological remission while preventing fibrostenotic complications  [1], [2], [3].

Aim. To compare histological and clinical remission rates between particular diets.

Results. The elemental diet is most effective (remission >90%) but is also associated with low patient compliance [4], [5]. Empirical diets show ~70% efficacy for 6FED [1], [6], while the 2FED (milk and wheat) achieves remission in 43–45% of cases, substantially reducing treatment burden [7], [8]). Cow’s milk remains the most frequent cause [8], [9]. There is a significant difference between symptom relief and histological healing that has led to biopsy-driven monitoring [10], [11].

Conclusions. Dietary therapy is a very effective, non-pharmacological treatment for EoE. The Step-Up approach (initially beginning with 2FED) is the preferred strategy to balance clinical efficacy with patient quality of life [7], [9], [12]. Multidisciplinary care is needed to mitigate the nutritional risks and psychological stress of long-term food elimination [5], [11].