Module 9 References-Chang et al Clin Gastro Hepatol 2023 Development of a practical guide to implement and monitor diet therapy for EoE

Chang et al Clin Gastro Hepatol 2023 Development of a practical guide to implement and monitor diet therapy for EoE

Pdf Summary

This narrative review by Joy W. Chang, et al., discusses developing a practical, evidence-based guide for implementing and monitoring diet therapy for Eosinophilic Esophagitis (EoE). EoE is a chronic inflammatory disease of the esophagus triggered by food allergens and characterized by symptoms like dysphagia and esophageal dysfunction. Although dietary therapy is effective, the success of its clinical implementation demands a multidisciplinary approach that is often hampered by a lack of resources and standardized guidelines. <br /><br />The article outlines primary treatments such as food elimination diets, medications like proton pump inhibitors, topical corticosteroids, and dupilumab. Elimination diets are an effective non-pharmacologic alternative but require strict adherence and frequent endoscopies to monitor response.<br /><br />The document details three phases in dietary therapy:<br />1. <strong>Elimination Phase</strong>: Removing common food allergens to induce disease remission.<br />2. <strong>Reintroduction Phase</strong>: Systematically reintroducing foods to identify specific triggers.<br />3. <strong>Maintenance Phase</strong>: Long-term avoidance of identified trigger foods.<br /><br />Challenges in diet therapy include potential overly restrictive diets, nutritional deficiencies, patient non-compliance, and the need for frequent endoscopies. A multidisciplinary approach involving dietitians is recommended, although access is limited. No standardized dietary resources for EoE exist, and the review provides practical guidelines to support clinicians in managing EoE dietary therapy.<br /><br />The review’s rationale emphasizes the inefficacy of conventional allergy testing for identifying food triggers in EoE, advocating empiric elimination diets targeting common triggers (e.g., milk, wheat). Patient preferences and shared decision-making are crucial, although physician attitudes towards diet therapy are often skeptical.<br /><br />Ultimately, dietary therapy is touted for its non-pharmacologic benefits and patient preference despite its complexities, advocating for better clinical resource allocation and provider education to improve implementation outcomes.

Keywords

Eosinophilic Esophagitis

diet therapy

food allergens

dysphagia

elimination diets

multidisciplinary approach

endoscopies

nutritional deficiencies

shared decision-making

clinical guidelines