title: Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Various dietary interventions have been used to treat patients with eosinophilic esophagitis (EoE), yielding varied results. This systematic review assesses the efficacy of different dietary therapies in inducing disease remission.
  
  
  METHODS
  We performed a systematic search of the MEDLINE, EMBASE, and SCOPUS databases for studies investigating the efficacy of dietary interventions (reducing infiltration by immune cells <15 eosinophils/high-power field in esophageal biopsies) for pediatric and adult patients with EoE. Summary estimates, including 95% confidence intervals (CI), were calculated for exclusive feeding with amino acid-based elemental formulas, allergy test result-directed food elimination diets, and 6-food elimination diets (SFED). A fixed- or random-effects model was used depending on heterogeneity (I(2)); publication bias risks were assessed by means of funnel plot analysis.
  
  
  RESULTS
  The search yielded 581 references; of these, 33 were included in the quantitative summary. We analyzed data on a total of 1317 patients with EoE (1128 children and 189 adults) who received different dietary treatments. Elemental diets were effective for 90.8% of cases (95% CI, 84.7%-95.5%; I(2) = 52.3%), SFED for 72.1% (95% CI, 65.8%-78.1%; I(2) = 0), and allergy test result-directed food elimination for 45.5% of cases (95% CI, 35.4%-55.7%; I(2) = 75.1%). Additional strategies (elimination of cow's milk, gluten-free diets, and 4-food elimination diet) were also evaluated. Adults vs children had no significant differences in remission after dietary interventions (67.2% vs 63.3%).
  
  
  CONCLUSIONS
  Dietary interventions are effective in producing histologic remission in patients with EoE. Elemental diets and SFEDs were the most effective, achieving <15 eosinophils/high-power field in 90.8% and 72.1% of patients, respectively.
authors.affiliation: Research Unit, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Arias
authors.affiliation: Department of Allergy, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: González-Cervera
authors.affiliation: Research Unit, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Tenias
authors.affiliation: Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain. Electronic address: alucendo@vodafone.es.
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D057765:Eosinophilic Esophagitis / Q000178:diet therapy* / Q000453:epidemiology / Q000276:immunology / Q000473:pathology; D004947:Esophagus / Q000276:immunology* / Q000473:pathology; D006801:Humans; D012074:Remission Induction; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Esophagus; Immune Regulation; Inflammation; Therapy