Elimination diets for eosinophilic esophagitis: making the best choice

Introduction: Dietary elimination therapy has long been an option for patients with eosinophilic esophagitis (EoE). Multiple diets have been reported, with variable efforts involved, efficacy rates, costs, and long-term management plans. Although the pros and cons of dietary elimination therapy have been described, a clear method for deciding on who is the right candidate for a diet, and which diet is best for that candidate, has not been clearly delineated. Areas covered: This article covers the benefits and challenges of dietary elimination therapies for patients with EoE. It outlines factors to consider before opting for an elimination diet, and for choosing which specific elimination diet to follow. Efficacy rates and pros and cons of each specific elimination diet are also discussed. Peer-reviewed published studies testing various elimination diets in patients with EoE were used for that purpose. Expert opinion: Dietary elimination therapy is a long-term management option for patients with EoE. Shared decision making involving the patient and the medical provider is important. Multiple factors including demographics, diet, nutritional status, social and financial support, and acceptance of multiple endoscopies need to be considered. Ongoing multi-disciplinary support during the initiation and maintenance phases of the diet is crucial to ensure good outcomes.