Diet Therapy for Eosinophilic Esophagitis
Several studies have looked at the differences between responders and nonresponders to diet, but few have found clear differences between the groups. Two studies looking at an allergy-directed elimination diet have found nonresponders to be slightly older. Other suggestions for nonresponders to the allergy testing-directed elimination diet have included noncompliance and limitations to the number of foods tested by skin prick testing or atopy patch testing. Geographic differences have also been proposed with a recent study from Spain showing responders to be increasingly sensitized to legumes and tomatoes. Possible non-food-related triggers for disease activation have been suggested by animal models as well as epidemiologic studies observing seasonal variation in the incidence of EoE in children and adults. Presently, however, the evidence for environmental aeroallergen activation of EoE is limited.
Comparing nonresponders to responders treated with an empiric elimination diet, complaints of heartburn and later enrollment in the study were significant predictors of response. Later enrollment as a predictor of response was suggested to be because of more individualized dietary education as the study progressed, potentially highlighting the overall difficulties in following dietary therapy. Endoscopic findings of rings and strictures had a decreased likelihood of response, supporting the concept of the difficulty in reversing fibrostenotic complications of the disease with therapies directed at the inflammatory response. A recent study suggests gene expression differences between responders and nonresponders. Twenty-eight EoE patients were examined and defined as responders (<5 eos/hpf after SFED) and nonresponders (>5 eos/hpf after SFED). Nonresponders had decreased expression of epithelial barrier and repair genes as compared with responders, suggesting mechanistic differences between the groups.
Response to Diet
Several studies have looked at the differences between responders and nonresponders to diet, but few have found clear differences between the groups. Two studies looking at an allergy-directed elimination diet have found nonresponders to be slightly older. Other suggestions for nonresponders to the allergy testing-directed elimination diet have included noncompliance and limitations to the number of foods tested by skin prick testing or atopy patch testing. Geographic differences have also been proposed with a recent study from Spain showing responders to be increasingly sensitized to legumes and tomatoes. Possible non-food-related triggers for disease activation have been suggested by animal models as well as epidemiologic studies observing seasonal variation in the incidence of EoE in children and adults. Presently, however, the evidence for environmental aeroallergen activation of EoE is limited.
Comparing nonresponders to responders treated with an empiric elimination diet, complaints of heartburn and later enrollment in the study were significant predictors of response. Later enrollment as a predictor of response was suggested to be because of more individualized dietary education as the study progressed, potentially highlighting the overall difficulties in following dietary therapy. Endoscopic findings of rings and strictures had a decreased likelihood of response, supporting the concept of the difficulty in reversing fibrostenotic complications of the disease with therapies directed at the inflammatory response. A recent study suggests gene expression differences between responders and nonresponders. Twenty-eight EoE patients were examined and defined as responders (<5 eos/hpf after SFED) and nonresponders (>5 eos/hpf after SFED). Nonresponders had decreased expression of epithelial barrier and repair genes as compared with responders, suggesting mechanistic differences between the groups.
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