Elimination diets effective for patients with eosinophilic esophagitis

A systematic review and meta-analysis of 34 studies found that a six-food elimination diet was not significantly better than less restrictive dietary regimens for histological remission and clinical symptom improvement.

Elimination diets are an effective treatment for eosinophilic esophagitis (EoE), and more restrictive diets aren't necessarily better, a recent study found.

Researchers performed a systematic review and meta-analysis of studies published through September 2022 to evaluate efficacy of four major dietary treatment regimens for EoE: the six-food elimination diet (no dairy, wheat or gluten, eggs, legumes, nuts, or seafood), the four-food elimination diet (no dairy, wheat or gluten, eggs, or legumes), the one-food elimination diet (exclusion of dairy products), and the targeted elimination diet (food exclusion guided by results of standard allergy testing). The results were published Jan. 30 by Clinical Gastroenterology and Hepatology.

Thirty-four studies involving 1,762 patients met the inclusion criteria. Overall, 701 patients (39.8%) were treated with the six-food elimination diet, 302 (17.1%) with the four-food elimination diet, 306 (17.4%) with the one-food elimination diet, and 453 (25.7%) with the targeted elimination diet. Median duration of dietary treatment was six weeks. The rate of histological remission of EoE was 53.8% (95% CI, 48.0% to 59.6%) overall, 61.3% (95% CI, 53.0% to 69.3%) for the six-food elimination diet, 49.4% (95% CI, 32.5% to 66.3%) for the four-food elimination diet, 51.4% (95% CI, 42.6% to 60.1%) for the one-food elimination diet, and 45.7% (95% CI, 32.0% to 59.7%) for the targeted elimination diet. Rates of histological remission did not vary significantly by dietary regimen and patient age. The rate of clinical response was 80.8% (95% CI, 72.3% to 88.2%) overall and 92.8% (95% CI, 81.2% to 99.6%), 74.1% (95% CI, 49.8% to 92.6%), 87.1% (95% CI, 58.4% to 99.9%), and 69.0% (95% CI, 50.2% to 85.3%), respectively, for the individual diets. A meta-regression model did not reveal any one type of diet to be a significant influencing factor in correlation with histological response.

The study was limited by lack of information on patients' adherence to the diets and by a high amount of heterogeneity among the included studies, in addition to other factors, the researchers noted. They concluded that dietary therapy is effective for treating EoE and that since six-food elimination diets showed no significant benefit over other options, one- and four-food elimination diets can be considered when patients would prefer a less restrictive dietary approach. “Compliance issues can hamper maintaining dietary control over an extended period of time,” the authors wrote. “Continuous and precise evaluation of dietary intake in patients diagnosed with EoE should become an established routine, as diet modification can significantly improve remission rates.”