Module 9 References-Doerfler et al Gastrol Hepatol 2023 Dietary management of EoE

Doerfler et al Gastrol Hepatol 2023 Dietary management of EoE

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Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition triggered by food antigens, characterized by esophageal dysfunction and tissue eosinophilia. This article by Doerfler, Lam, and Gonsalves explores various dietary management strategies for both pediatric and adult patients with EoE.<br /><br />Historically, dietary therapy for EoE gained traction following pediatric studies in the 1990s, wherein the elimination of dietary proteins significantly improved symptoms and reduced eosinophil counts. Research has since expanded to include several dietary restriction levels, such as the elemental diet, two-food, four-food, and six-food elimination diets (SFED), with varying efficacy and outcomes. The elemental diet shows the highest histologic response but faces challenges like poor palatability, quality of life impacts, and high costs. Conversely, empiric elimination diets like SFED have emerged as effective and more feasible options, evidenced by a 67.9% histologic remission rate in observational studies.<br /><br />The pathophysiology of EoE involves a complex interplay between genetic predisposition, food allergens, and TH2-mediated immune responses. Interestingly, recent studies propose that EoE might be associated with immunoglobulin G4 (IgG4) rather than the traditional immunoglobulin E (IgE), prompting new research into IgG4-directed elimination diets.<br /><br />Choosing the right dietary therapy involves shared decision-making with patients, considering their preferences, lifestyle, and nutritional needs. Nutritional assessments by registered dietitians are crucial, especially to monitor potential deficiencies and ensure a balanced intake during and after the elimination phase. Moreover, practical tips for implementation, food reintroduction, and managing dietary adherence are discussed to aid clinicians in optimizing treatment plans.<br /><br />Although dietary therapy is efficacious, some patients may require salvage therapies such as proton pump inhibitors (PPIs) or swallowed corticosteroids if initial diet-based interventions fail. Additionally, recent advancements in minimally invasive diagnostic tools, like the Esophageal String Test and Cytosponge, offer promising alternatives to frequent endoscopies during food reintroduction and monitoring phases.<br /><br />In conclusion, while existing dietary therapies provide significant benefits for managing EoE, ongoing research into individualized treatment approaches and innovative diagnostic tools continues to enhance care for EoE patients.

Keywords

Eosinophilic esophagitis

immune-mediated condition

dietary management

pediatric patients

elemental diet

food elimination diets

histologic response

IgG4

nutritional assessments

diagnostic tools