OBJECTIVE

To synthesize current evidence on the efficacy of dietary interventions in patients with eosinophilic esophagitis and to illustrate the clinical application of dietary therapy using case series.

KEY POINTS

Dietary therapy as a first-line treatment for eosinophilic esophagitis demonstrates efficacy comparable to pharmacologic therapy with proton pump inhibitors and topical corticosteroids. A six-food elimination diet achieves histological remission in 61.3—63.9% of patients. Less restrictive regimens excluding only milk and dairy products are associated with remission rates of approximately 46.4—51.4%. Elimination diets excluding two or four food groups result in histological remission in 44.3—54.7% of cases. Elemental diets based on amino acid formulas induce remission in more than 90% of patients; however, their clinical utility is limited by poor adherence and they should be reserved for cases refractory to other therapeutic approaches. Diets guided by allergy testing (skin prick tests and serum-specific IgE) show the lowest and most variable efficacy (39.5—45.7%), which restricts their role in the management of eosinophilic esophagitis.

CONCLUSION

Elimination diets may be employed in eosinophilic esophagitis either as monotherapy or in combination with pharmacologic treatment when monotherapy is insufficient. Current dietary strategies favor initiating treatment with less restrictive regimens (exclusion of dairy products alone or milk and gluten), followed by a step-up approach with broader food elimination in patients who fail to achieve histological remission. Diets based on allergy testing are appropriate only in patients with confirmed concomitant food allergy.