Eosinophilic esophagitis in adults and children: evidence for a food allergy component in many patients.

PURPOSE OF REVIEW: Eosinophilic esophagitis is a recently recognized disorder receiving increasing attention. Patients present with symptoms of gastroesophageal reflux and are not responsive to standard or aggressive reflux medications. This article reviews all literature published in English from December 2005 to November 2006 from PubMed on the topic of eosinophilic esophagitis.

RECENT FINDINGS: Three articles have confirmed that food allergies are causative in more than 90% of patients. Three different diet strategies were used: elemental, elimination diet based on the prick-skin test, and the atopy patch test or removal of the six most common foods. The elemental diet had the highest success rate (> 95%), whereas the testing-based elimination diet (> 75%) and six-food elimination diet (> 70%) had lower success rates. There are no organized dietary trials in adults.

SUMMARY: Recent literature on pediatric patients with eosinophilic esophagitis confirms that nearly all patients respond to an elemental diet with resolution of symptoms and normalization of biopsies. Although diets based on testing or removal of the most common allergens showed success, they were less successful than a complete elimination diet. Unfortunately, there are very limited studies in adults that address this issue.