Which patients with eosinophilic esophagitis (EoE) should receive elemental diets versus other therapies?

Eosinophilic esophagitis (EoE) has increasingly been identified in both children and adults. The aim of therapies is to alleviate symptoms while reducing the esophageal inflammation. Mechanical dilation is effective at relieving symptoms, but without the benefit of controlling disease inflammation. Topical steroids appear to be effective at controlling both symptoms and esophageal eosinophilia. Recurrence rates are high once steroids are discontinued. For dietary modification, both the elimination of select, specific foods and the complete elimination of food proteins via amino acid formulas have been looked at. Both forms of dietary modification are effective. Elemental diet, although not an ideal first-line therapy for EoE, provides insight into the etiology of unusual or refractory EoE. The contribution of unusual food antigens to EoE may be determined via the use of amino-acid-based formulas in patients with EoE.