Eosinophilic esophagitis (EoE) is a unique form of non‐immunoglobulin E‐mediated food allergy, restricted to the esophagus, characterized by esophageal eosinophil‐predominant inflammation and dysfunction. The diagnosis requires an esophago‐gastroduodenoscopy with esopha-geal biopsies demonstrating active eosinophilic inflammation with 15 or more eosino-phils/high‐power field, following the exclusion of alternative causes of eosinophilia. Food allergens trigger the disease, withdairy/milk, wheat/gluten, egg, soy/legumes, and seafood the most com-mon. Therapeutic strategies comprise dietary restrictions, proton pump inhibitors, topical cortico-steroids, biologic agents, and esophageal dilation when strictures are present. However, avoidance of trigger foods remains the only option targeting the cause, and not the effect, of the disease. Be-cause EoE relapses when treatment is withdrawn, dietary therapy offers a long‐term, drug‐free alternative to patients who wish to remain off drugs and still be in remission. There are currently multiple dietary management strategies to choose from, each having its specific efficacy, ad-vantages, and disadvantages that both clinicians and patients should acknowledge. In addition, dietary regimens should be tailored around each individual patient to increase the chance of tol-erability and long‐term adherence. In general, liquid elemental diets devoid of antigens and elimination diets restricting causative foods are valuable options. Designing diets on the basis of food allergy skin tests results is not reliable and should be avoided. This review summarizes the most recent knowledge regarding the clinical use of dietary measures in EoE. We discussed endpoints, rationale, advantages and disadvantages, and tailoring of diets, as well as currently available dietary regimens for EoE.

Dietary management of eosinophilic esophagitis: Tailoring the approach

Zingone F.;Ghisa M.;Savarino E. V.;
2021

Abstract

Eosinophilic esophagitis (EoE) is a unique form of non‐immunoglobulin E‐mediated food allergy, restricted to the esophagus, characterized by esophageal eosinophil‐predominant inflammation and dysfunction. The diagnosis requires an esophago‐gastroduodenoscopy with esopha-geal biopsies demonstrating active eosinophilic inflammation with 15 or more eosino-phils/high‐power field, following the exclusion of alternative causes of eosinophilia. Food allergens trigger the disease, withdairy/milk, wheat/gluten, egg, soy/legumes, and seafood the most com-mon. Therapeutic strategies comprise dietary restrictions, proton pump inhibitors, topical cortico-steroids, biologic agents, and esophageal dilation when strictures are present. However, avoidance of trigger foods remains the only option targeting the cause, and not the effect, of the disease. Be-cause EoE relapses when treatment is withdrawn, dietary therapy offers a long‐term, drug‐free alternative to patients who wish to remain off drugs and still be in remission. There are currently multiple dietary management strategies to choose from, each having its specific efficacy, ad-vantages, and disadvantages that both clinicians and patients should acknowledge. In addition, dietary regimens should be tailored around each individual patient to increase the chance of tol-erability and long‐term adherence. In general, liquid elemental diets devoid of antigens and elimination diets restricting causative foods are valuable options. Designing diets on the basis of food allergy skin tests results is not reliable and should be avoided. This review summarizes the most recent knowledge regarding the clinical use of dietary measures in EoE. We discussed endpoints, rationale, advantages and disadvantages, and tailoring of diets, as well as currently available dietary regimens for EoE.
File in questo prodotto:
Non ci sono file associati a questo prodotto.
Pubblicazioni consigliate

Caricamento pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11577/3394281
Citazioni
  • ???jsp.display-item.citation.pmc??? 2
  • Scopus 6
  • ???jsp.display-item.citation.isi??? 4
social impact