Treatment of adult eosinophilic esophagitis with diet

A growing body of research indicates that dietary therapy is an effective treatment option for children with eosinophilic esophagitis (EoE). Its ability to achieve sustained symptomatic and histological responses is comparable to that of topical steroids, but avoids their use and side effects. Recent studies also support dietary therapy as a preferred treatment option for adult patients.

A comprehensive literature review was carried out to assess the efficacy of the most commonly used dietary interventions in inducing and maintaining disease remission in adult EoE patients as compared with results from pediatric studies.

The only available study assessing exclusive feeding with an elemental diet carried out in adults demonstrated a 94% disease remission rate, comparable to the high efficacy reported in pediatric studies. The major drawbacks of this therapy are poor adherence and a rapid disease recurrence after resumption of a normal diet. Although there is limited data on skin allergy testing-directed food elimination in adult patients, the highest efficacy rates observed do not exceed 26% histological remission. Prospective studies on empirical six-food elimination diets in adults provided efficacy rates comparable to those reported in children, achieving disease remission in approximately 75% of patients. However, specific food triggers can only be identified after documented recurrence of eosinophilic inflammation as determined with repeated endoscopic biopsies. Prolonged avoidance of the offending food(s) produces sustained remission of adult EoE.

Diet is a feasible therapeutic option for adult EoE patients, providing them with the same effective drug-free alternative as in pediatric patients.