title: Update on dietary therapy for eosinophilic esophagitis in children and adults.
abstract: Eosinophilic esophagitis (EoE) is a chronic inflammatory esophageal disease triggered predominantly, but not excusively, by food antigens. Elimination diet thus remains the only therapy targeting the cause of the disease. Importantly, EoE is a unique form of non-IgE mediated food allergy, largely dependant upon delayed, cell-mediated hypersensitivity. Areas covered: A comprehensive review of literature to summarize and update the most relevant advances on dietary therapy for pediatric and adult EoE patients is conducted. Expert commentary: None of the currently available food allergy tests adequately predict food triggers for EoE, especially in adults. Elemental diet (exclusive feeding with aminoacid-based formulas) and empiric six-food elimination diet, withdrawing cow´s milk, wheat, egg, soy, nuts and fish/seafood for 6 weeks, have consistently shown the best cure rates. However, their high level of restriction and need for multiple endoscopies (top-down approach) have been a deterrent for patients and physicians. Less restrictive empiric schemes, like a four-food (animal milk, gluten-containing cereals, egg, legumes) or a two-food (animal milk and gluten-containing cereals) elimination diet have lately shown encouraging results. Therefore, a novel step-up strategy (2-4-6) may enhance patient uptake and promptly identify most responders to empiric diets with few food triggers, besides saving unnecessary dietary restrictions and endoscopic procedures.
authors.affiliation: a Department of Gastroenterology , Hospital Universitario San Pedro de Alcantara , Caceres , Spain.|b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Madrid , Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.affiliation: a Department of Gastroenterology , Hospital Universitario San Pedro de Alcantara , Caceres , Spain.
authors.forename: Pedro Luis
authors.initials: PL
authors.lastname: Gonzalez-Cordero
authors.affiliation: b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Madrid , Spain.|c Research Unit, Complejo Hospitalario La Mancha Centro , Alcázar de San Juan , Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Arias
authors.affiliation: b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD) , Madrid , Spain.|d Department of Gastroenterology , Hospital General de Tomelloso , Tomelloso , Spain.
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
mesh_terms: D000328:Adult; D000367:Age Factors; D002648:Child; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000178:diet therapy* / Q000276:immunology; D005512:Food Hypersensitivity / Q000175:diagnosis / Q000178:diet therapy* / Q000276:immunology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000175:diagnosis / Q000178:diet therapy* / Q000276:immunology; D007111:Immunity, Cellular; D007159:Immunologic Tests; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Eosinophilic esophagitis; diet; egg; food allergy; milk; wheat