Efficacy of a Dairy-Free Diet in Adult Patients With Eosinophilic Esophagitis: A Pilot Prospective Multicenter Study

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease in which elimination diets represent an effective therapeutic option. Although six-food elimination diets (6-FED) achieve high remission rates, their complexity often compromises adherence. Dairy-free diet (DFD) has emerged as a simpler alternative, yet evidence in adult populations remains limited.

To evaluate the clinical, endoscopic, and histological outcomes of a 12-week DFD in adult patients with EoE and to explore potential predictors of histological remission and dietary adherence.

We conducted a prospective, multicenter, open label, single-arm interventional study across five Italian referral centers, enrolling 31 adults with active EoE. Participants followed a 12-week DFD, after which clinical symptoms (EEsAI), disease severity (I-SEE), endoscopic findings (EREFS), quality of life (EoE-QOL-A), and adherence (VAS scale) were assessed.

Twenty-eight patients completed the 12-week protocol. Histological remission was achieved in 53.6% of patients (intention-to-treat: 48.4%); among these, 86.7% also reached clinical remission. The median EEsAI improved from 35 to 18.5 (p = 0.009) and the median I-SEE score from 6.5 to 4 (p < 0.0001). Quality of life improved (median EoE-QoL-A from 36.5 to 52, p = 0.02), and adherence was high (median VAS 8 [IQR 7-9.5]). Predictors of lower histological response included previous esophageal dilations and higher baseline exudate and eosinophil counts. Male sex and higher BMI predicted lower adherence.

In this exploratory multicenter prospective study, DFD induced histological remission in more than half of patients and clinically meaningful improvements in symptoms, disease severity, endoscopy, and quality of life.