Dietary Therapy Can Be Extremely Helpful for Patients With Eosinophilic Esophagitis

Dietary Therapy Can Be Extremely Helpful for Patients With Eosinophilic Esophagitis

Prateek Sharma, MD, FASGE, reviewing Mayerhofer C, et al. Clin Gastroenterol Hepatol 2023 Jan 30.

There are several elimination diet regimens available, including the 6-food elimination diet (SFED), 4-food elimination diet (FFED), one-food elimination diet (OFED), and targeted elimination diet (TED). SFED removes the most common food antigens, whereas FFED eliminates fewer foods and may offer increased dietary adherence and quality of life. OFED targets cow’s milk, which is a widespread trigger for eosinophilia esophagitis (EoE). TED uses standard allergy testing to guide dietary elimination, but this method is disputed as poorly correlated to histologic assessment results. Initial reports demonstrate good efficacy and no negative effect on nutritional status for SFED and FFED.

This systematic review included 34 studies comprising a total patient group of 1762, both adults and children. Of these patients, 39.8% had been treated with SFED, 17.1% with FFED, 17.4% with OFED, and 25.7 % with TED. The median duration of a dietary regimen was 6 weeks (interquartile range, 6-8 weeks). The overall rate of histologic remission was 53.8%, with SFED having the highest rate at 61.3%, followed by OFED at 51.4%, FFED at 49.4%, and TED at 45.7%. The dietary regimen and patient age did not significantly affect the rates of histologic remission. 

The overall clinical response was assessed in 930 patients from 18 studies and was 80.8%. Clinical response rates were higher, when compared with histologic response rates, in each dietary group: 92.8% for SFED, 74.1% for FFED, 87.1% for OFED, and 69.0% for TED.

Prateek Sharma, MD, FASGE


Dietary therapy is an effective treatment option for EoE. Empirical diets can result in high rates of histologic and clinical remission without the need for prior clinical testing of food sensitization. SFED does not appear to be significantly better than other dietary regimens; therefore, OFED and FFED can be considered alternative options for better adherence.


Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Mayerhofer C, Kavallar AM, Aldrian D, Lindner AK, Müller T, Vogel GF. Efficacy of elimination diets in eosinophilic esophagitis: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2023 Jan 30. (Epub ahead of print) (

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