Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach

Abstract

Eosinophilic esophagitis (EoE) is a chronic allergic disease defined by a marked eosinophilic inflammation and symptoms of esophageal dysfunction. EoE is a heterogeneous disease and severely impacts the quality of life of affected patients. The current therapeutic management of EoE is based on two cornerstones: medication and diet therapy, both effective but limited by several critical issues. The choice of one or the other therapy might depend on the different disease phenotypes (allergic vs. non-allergic, inflammatory vs. fibro-stenotic), patient's age (adult vs. childhood-onset), food habits, patient/family preference, and familiar financial resource. Diet therapy is a successful treatment but limited by low patient adherence, the need for several endoscopies, food restrictions, psychosocial impact, and potential nutritional deficiencies. All these limitations could be effectively overcome with multidisciplinary and personalized management. This review summarizes the most recent evidence on the dietary elimination approaches and will provide a practical guide to clinicians in managing and implementing dietary therapy for patients with EoE.

Dupilumab treatment of eosinophilic gastrointestinal disease in an adolescent

“…Moreover, diet treatment is often not feasible due to reliance on scopes for surveillance of treatment impact. 7 We present the case of a 14-year-old boy who is allergic to seasonal and perennial aeroallergens followed by the gastroenterology and allergy units of our hospital for EoE and non-EoE-EGIDs, which he has had since he was 8 years old, who failed the mentioned treatments with proton pump inhibitors, oral corticosteroids, and diet. At Since 2017, he has been in poor clinical condition with nausea, abdominal pain, poor appetite, recurrent vomiting, microcytic anemia, and weight loss.…”

“…Although he had good adherence to the therapy from 2019 to 2021, he required three cycles of oral prednisone and had a good clinical and histologic response but with sudden worsening of the disease as soon as oral corticosteroid treatment was stopped. In 2019, he started an empiric diet without eggs (chosen by the child out for disgust) and milk (proposed by clinicians because the histologic remission varies from 44% to 70% 7 ) with no clinical or histologic improvement (Figure 1).…”

First Therapeutic Approval for Eosinophilic Esophagitis

“…Some adults and many children with EE show improvement with proton pump inhibitors [ 34 – 36 ] as well as diet modification so that the food that triggers allergy is removed, particularly egg, milk, wheat, soy, nuts, and fish [ 37 , 38 ]. Some patients require a liquid formula diet provided via a feeding tube.…”

Evaluation of diagnostic time in pediatric patients with eosinophilic gastrointestinal disorders according to their clinical features

“…FTT is a clinical complication often reported in toddlers and young children with severe active EoE that might require child hospitalization and the restoration of nutritional needs with large volumes of the aminoacid-based formula [12]. This study highlighted that it is fundamental to identify all delay points, starting with raising awareness among family pediatricians on EGIDs and promptly referring suspicious cases to specialized pediatric centers with a multidisciplinary team.…”

“…Common GI inflammatory disorders, such as celiac disease, are often associated with FTT, weight loss, and delayed puberty. FTT is a clinical complication often reported in toddlers and young children with severe active EoE that might require child hospitalization and the restoration of nutritional needs with large volumes of the aminoacid-based formula [ 12 ].…”