Elimination diets in eosinophilic esophagitis
Näytönastekatsaukset
9.6.2025
Level of evidence: D
A food-elimination diet might have little impact on the histological representation of eosinophilic esophagitis compared to no diet, but the evidence is insufficient.
The limitations in the current literature make it difficult to have any firm statement on the effects of food-elimination diets versus no diet. One higher quality RCT compared 1-food elimination diet to 6-food elimination diet and found no benefit in eosinophilic counts, but the results were imprecise (Change difference 0.72 [0.43 – 1.20], favoring 6FED).
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Kliewer K, Aceves SS, Atkins D ym. 817 – Efficacy of 1-food and 4-food elimination diets for pediatric eosinophilic esophagitis in a randomized multi-site study. Gastroenterology. 2019; 156 (S-172–S-1»1 | RCT | Adults with active and symptomatic EoE | 1FED (animal milk) vs 6FED (animal milk, wheat, egg, soy, fish, shellfish, peanut and tree nuts) | Peak eosinophil count at 6 weeks | moderate |
| «Mayerhofer C, Kavallar AM, Aldrian D, ym. Efficacy of Elimination Diets in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2023;21(9):2197-2210.e3 »2 | Systematic review and meta-analysis | Adults and children with active EoE | 1-6 Food elimination diets. Most studies with no control group. | Histologic remission (15 or fewer eosinophils per HPF) | high |
| Reference | Comments |
|---|---|
| «Kliewer K, Aceves SS, Atkins D ym. 817 – Efficacy of 1-food and 4-food elimination diets for pediatric eosinophilic esophagitis in a randomized multi-site study. Gastroenterology. 2019; 156 (S-172–S-1»1 | Randomisation and allocation concealment ok, study investigators and patients were not blinded, very little missing data (5/129). ITT analysis. |
| «Mayerhofer C, Kavallar AM, Aldrian D, ym. Efficacy of Elimination Diets in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2023;21(9):2197-2210.e3 »2 | Comprehensive systematic search strategy. 30/34 were observational studies from which most did not have comparison groups. Study quality by the authors: quality assessment median score 7/10, Risk of bias was low in 4 studies, moderate in 26 and serious in 4 studies. |
Results
| Reference | Number of patients (I/C) | Follow-up time | Intervention group mean | Control group mean | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| 1. Peak eosinophil count | I 62 / C 67 | 6 weeks | Baseline: 38.4 (95% CI 32.8 – 44.9) Follow up: 10.9 (7.3 – 16.5) | Baseline: 50.3 (95% CI 42.2 – 60.0) Follow up: 20.8 (15.0 – 28.9) | Change difference 0.72 (0.43 – 1.20) (in favor of intervention) |
| 2. Histologic remission | 34 studies with 1762 patiens; 701 in 6FED, 302 in 4FED, 306 in 1FED, 453 in targeted FED | Median 6 weeks (IQR 6-8) | Follow up: 6FED: 61.3% (95% CI 53.0% - 69.3%), 4FED: 49.4% (95% CI 32.5% - 66.3%), 1FED: 51.4% (42.6% - 60.1%) tFED: 45.7% (32.0% - 59.7%) | - | - |
| Level of evidence: very low The quality of evidence is downgraded due to study limitations, inconsistency, indirectness, imprecision, and risk of bias. | |||||
References
- Kliewer K, Aceves SS, Atkins D ym. 817 – Efficacy of 1-food and 4-food elimination diets for pediatric eosinophilic esophagitis in a randomized multi-site study. Gastroenterology. 2019; 156 (S-172–S-173)
- Mayerhofer C, Kavallar AM, Aldrian D, ym. Efficacy of Elimination Diets in Eosinophilic Esophagitis: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2023;21(9):2197-2210.e3 «PMID: 36731591»PubMed