Chahuan Javier, Lucendo Alfredo J
Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.
Inflamm Intest Dis. 2024 Jul 5;9(1):184-198. doi: 10.1159/000540228. eCollection 2024 Jan-Dec.
The effectiveness of dietary therapy to induce remission of eosinophilic esophagitis (EoE) has been evaluated over the last decades and summarized in meta-analyses. Choosing the dietary modality, identifying the most suitable patients, and implementing specific prerequisites are essential to ensure long-term success.
Impractical exclusive elemental diets provided the highest remission rates in EoE; however, they are not recommended due to their numerous disadvantages and detrimental effects on patient quality of life. Allergy testing-guided diets for EoE are limited; their insufficient effectiveness and low reproducibility are due to poor accuracy of skin or serum test results in identifying EoE food triggers. Initial experiences with a six-food elimination diet have provided evidence of high and predictive effectiveness rates and paved the way for less restrictive and more efficient step-up approaches, including four-food, two-food, and most recently, milk elimination diets. Dietary treatment for EoE is challenging for patients and families and requires certain skills to ensure success in the short and long term.
The selection of appropriate patients is essential to ensure the success of and long-term adherence to dietary treatment of EoE. As normal triggers for EoE are commonly found in the staple diet, it is important to ensure adequate nutritional substitutes to avoid nutrient deficiency risks when long-lasting feeding difficulties or extensive restrictions are present. Specialized facilities in dietary therapy should adopt patient-centered and personalized approaches in order to provide timely monitoring and support for complex cases.
在过去几十年中，已对饮食疗法诱导嗜酸性食管炎（EoE）缓解的有效性进行了评估，并在荟萃分析中进行了总结。选择饮食方式、确定最合适的患者以及满足特定前提条件对于确保长期成功至关重要。
不实用的完全要素饮食在EoE中缓解率最高；然而，由于其诸多缺点以及对患者生活质量的不利影响，不推荐使用。针对EoE的过敏测试指导饮食有限；其有效性不足和再现性低是由于皮肤或血清测试结果在识别EoE食物触发因素方面准确性较差。六食物排除饮食的初步经验提供了高有效率和预测有效率的证据，并为限制更少、效率更高的逐步升级方法铺平了道路，包括四食物、两食物以及最近的牛奶排除饮食。EoE的饮食治疗对患者及其家庭具有挑战性，需要一定技能以确保短期和长期的成功。
选择合适的患者对于确保EoE饮食治疗的成功和长期坚持至关重要。由于EoE的常见触发因素通常存在于主食中，当存在长期喂养困难或广泛限制时，确保充足的营养替代物以避免营养缺乏风险很重要。饮食治疗的专业机构应采用以患者为中心的个性化方法，以便为复杂病例提供及时的监测和支持。
