Illuminating Elimination Diets: Controversies Regarding Dietary Treatment of Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is an immune-mediated disease triggered by food antigens for which dietary elimination treatment can induce and sustain histologic remission. Our review aims to describe the state of the art regarding dietary treatment of EoE, highlighting a number of areas of controve...

Full description

Saved in:
Bibliographic Details
Published in:Digestive diseases and sciences 2019-06, Vol.64 (6), p.1401-1408
Main Authors: Cotton, Cary C., Durban, Raquel, Dellon, Evan S.
Format: Article
Language:English
Subjects:
Allergens - adverse effects
Allergens - immunology
Allergic reaction
Allergies
Allergy
Animals
Antigens
Asthma
Autoimmune diseases
Barley
Biochemistry
Care and treatment
Costs
Cross Reactions
Diet
Disease
Endoscopy
Eosinophilic Esophagitis - diet therapy
Eosinophilic Esophagitis - immunology
Esophageal diseases
Esophagitis
Esophagus
Food
Food Hypersensitivity - diet therapy
Food Hypersensitivity - immunology
Gastroenterology
Gastrointestinal diseases
Genotype & phenotype
Hepatology
Humans
Immunoglobulin E
Invited Review
Medical colleges
Medicine
Medicine & Public Health
Oncology
Pathogenesis
Pediatrics
Risk Factors
Testing
Transplant Surgery
Treatment Outcome
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Eosinophilic esophagitis (EoE) is an immune-mediated disease triggered by food antigens for which dietary elimination treatment can induce and sustain histologic remission. Our review aims to describe the state of the art regarding dietary treatment of EoE, highlighting a number of areas of controversy related to dietary therapy in EoE, including novel modalities for determining food triggers, making the empiric dietary elimination process more efficient, issues of cross-contamination and “dosing” of how much food to avoid or add back, costs and effects on quality of life, long-term efficacy, and the risk of developing immediate IgE-type reactions after initial dietary elimination. Elemental formulas, empiric elimination diets, and targeted allergy test-directed elimination diets are well-described treatments for EoE. Although elemental diets are most efficacious, their clinical use is limited by cost and the palatability of an exclusively liquid diet. While empiric elimination is less effective than elemental formula-based diets, they are more easily implemented and often sustainable. Since the comparative effectiveness of elimination diets with proton-pump inhibitors and swallowed topical steroids remains unknown, there are multiple areas to address with future research.
ISSN:0163-2116
1573-2568
DOI:10.1007/s10620-019-05602-w