DIETARY THERAPY IN THE TREATMENT OF EOSINOPHILIC ESOPHAGITIS: A COMPREHENSIVE REVIEW OF CLINICAL EVIDENCE

Maria Wieczorek; Jan Kownacki; Paweł Drzymała; Kacper T. Majczak; Marta Śliwińska; Magdalena G. Gehrke; Aleksandra Schmidt; Julian Uchacz; Oliwia Z. Śmiechowicz; Natalia A. Skwarek

doi:10.31435/ijitss.1(49).2026.5249

Authors

Maria Wieczorek Orłowski Independent Public Clinical Hospital, Centre of Postgraduate Medical Education, Warsaw, Poland https://orcid.org/0009-0000-9951-7509
Jan Kownacki The Infant Jesus Teaching Hospital, Warsaw, Poland https://orcid.org/0009-0004-6276-6383
Paweł Drzymała Central Clinical Hospital of UCC MUW, Warsaw, Poland https://orcid.org/0009-0006-6288-6232
Kacper T. Majczak Praga Hospital of Transfiguration of Our Lord Ltd., Warsaw, Poland https://orcid.org/0009-0000-4115-0513
Marta Śliwińska Praga Hospital of Transfiguration of Our Lord Ltd., Warsaw, Poland https://orcid.org/0009-0003-0710-4021
Magdalena G. Gehrke National Medical Institute of the Ministry of the Interior and Administration in Warsaw, Warsaw, Poland https://orcid.org/0009-0004-8141-4236
Aleksandra Schmidt John Paul II Western Hospital in Grodzisk Mazowiecki, Grodzisk Mazowiecki, Poland https://orcid.org/0009-0005-3725-739X
Julian Uchacz John Paul II Western Hospital in Grodzisk Mazowiecki, Grodzisk Mazowiecki, Poland https://orcid.org/0009-0005-4431-6343
Oliwia Z. Śmiechowicz District Health Center in Otwock, Otwock, Poland https://orcid.org/0009-0008-5803-7232
Natalia A. Skwarek The Infant Jesus Teaching Hospital, Warsaw, Poland https://orcid.org/0009-0001-2061-6158

DOI:

https://doi.org/10.31435/ijitss.1(49).2026.5249

Keywords:

Eosinophilic Esophagitis, Diet, EoE, Six-Food Elimination Diet, Four-Food Elimination Diet

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disorder of the esophagus characterized clinically by symptoms of esophageal dysfunction and by eosinophilic infiltration. EoE has emerged as a major cause of dysphagia and food impaction in both pediatric and adult populations. Accumulating evidence indicates that is primarily driven by antigen exposure, particularly food allergens, leading to a T helper type 2 (Th2)-mediated inflammatory cascade. Dietary therapy has become one of the three major therapeutic pillars of EoE management, alongside proton pump inhibitors and topical corticosteroids. This review synthesizes current evidence regarding dietary interventions in EoE and demonstrates that dietary therapy induces histologic remission in a substantial proportion of patients, with response rates exceeding 90% for elemental diets and approximately 70% for six-food elimination diets. However, dietary treatment carries risks of nutritional deficiencies, psychosocial burden, and the need for repeated endoscopic monitoring.

References

Dellon, E. S., et al. (2020). ACG clinical guideline: Eosinophilic esophagitis. American Journal of Gastroenterology.

Arias, Á., et al. (2016). Incidence and prevalence of eosinophilic esophagitis: Systematic review. Gastroenterology.

Jensen, E. T., & Dellon, E. S. (2013). Environmental factors and EoE. Journal of Allergy and Clinical Immunology.

Spergel, J. M. (2015). Eosinophilic esophagitis in children. Current Opinion in Pediatrics.

Aceves, S. S., et al. (2007). Remodeling in eosinophilic esophagitis. Journal of Allergy and Clinical Immunology.

Hirano, I., Moy, N., Heckman, M. G., et al. (2013). Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: Validation of a novel classification and grading system. Gut, 62(4), 489–495.

Straumann, A., Rossi, L., Simon, H. U., et al. (2003). Fragility of the esophageal mucosa: A pathognomonic endoscopic sign of primary eosinophilic esophagitis? Gastrointestinal Endoscopy, 57(3), 407–412.

Blanchard, C., & Rothenberg, M. E. (2008). Biology of eosinophilic esophagitis. Journal of Allergy and Clinical Immunology.

Kelly, K. J., et al. (1995). Elemental diet induces remission in EoE. Gastroenterology.

Kagalwalla, A. F., et al. (2006). Effect of dietary therapy on EoE. Clinical Gastroenterology and Hepatology.

Arias, Á., et al. (2014). Dietary interventions for EoE: Meta-analysis. Gastroenterology.

Warners, M. J., et al. (2018). Patient burden of dietary therapy. Alimentary Pharmacology & Therapeutics.

Gonsalves, N., et al. (2012). Six-food elimination diet induces remission. Gastroenterology.

Molina-Infante, J., et al. (2018). Step-up empiric elimination diet. Journal of Allergy and Clinical Immunology.

Kagalwalla, A. F., et al. (2012). Cow’s milk elimination in EoE. Clinical Gastroenterology and Hepatology.

Spergel, J. M., et al. (2012). Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. Journal of Allergy and Clinical Immunology.

Reed, C. C., & Dellon, E. S. (2018). Nutritional considerations in EoE. Current Gastroenterology Reports.

Muir, A. B., et al. (2016). Growth outcomes in pediatric EoE. Journal of Pediatric Gastroenterology and Nutrition.

Taft, T. H., et al. (2011). Quality of life in EoE. Clinical Gastroenterology and Hepatology.

Hirano, I., et al. (2017). Symptoms vs histology correlation. Gastroenterology.

Cotton, C. C., et al. (2017). Six-food elimination diet and topical steroids are effective for eosinophilic esophagitis: A meta-regression. Digestive Diseases and Sciences.

Arias, Á., et al. (2024). EUREOS Guidelines Committee. Efficacy of dietary therapy for eosinophilic esophagitis in children and adults: An updated systematic review and meta-analysis. Nutrients, 16(14), 2231.

Mukkada, V., et al. (2018). Health-related quality of life and costs associated with eosinophilic esophagitis: A systematic review. Clinical Gastroenterology and Hepatology.

Pitsios, C., et al. (2022). Allergy-test-based elimination diets for the treatment of eosinophilic esophagitis: A systematic review of their efficacy. Journal of Clinical Medicine.