Emerging concepts of dietary therapy for pediatric and adult eosinophilic esophagitis

Abstract

Each of these three studies has its own strengths and weaknesses, but collectively they highlight a broader picture of the role of food in EoE disease and management. Overall conclusions that can be drawn from these studies include: the elemental diet is superior to the SFED and skin test-directed diet; the SFED is similar to skin test-directed diet therapy in response rate and nearly similar in the number of foods eliminated in pediatric EoE; and the SFED is an effective therapy in adult EoE. Specifically with regards to the SFED, all three studies showed similar effectiveness of the SFED (based on histology), in agreement with previous reports. Gonsalves et al. "bibr" rid="ref-14"[14] demonstrated a 74% success rate and identified causative foods in 40% of patients studied. Henderson et al. "bibr" rid="ref-15"[15] demonstrated a 75% success rate with the SFED. Spergel et al. "bibr" rid="ref-16"[16] reported an 81% success rate with a modified SFED and identified causative foods in 34% of patients "table" rid="T1"(Table 1). Multiple studies have reported a response rate to swallowed steroids in both adult and pediatric EoE populations with response rates ranging from 50 to 87% "bibr" rid="ref-17 ref-18 ref-19 ref-20"[17-20], similar to the response rate of the empiric elimination diets reported above (including modified SFED). In addition, there appears to be potential to identify causative foods in 35-40% of patients. On the basis of these data, we propose a method for clinical management. It may be reasonable to begin therapy with an empiric elimination diet and reintroduce the foods least likely to be causative (based both on history and published data) first, thus allowing the quickest identification of the majority of foods. On the basis of the above studies, this would suggest reintroduction of seafood/nuts first, followed sequentially by soy, wheat, egg and finally milk for pediatric patients with EoE. For adults with EoE, the current data imply reintroduction of seafood first, followed sequentially by egg, nuts/soy, milk and finally wheat "table" rid="T2"(Table 2). The value of this approach should ultimately be evaluated with controlled clinical trials. © 2013 Expert Reviews Ltd.