{"doi":"10.1016/j.cgh.2023.03.006","title":"Development of a Practical Guide to Implement and Monitor Diet Therapy for Eosinophilic Esophagitis","abstract":"Dietary therapy for short- and long-term management of eosinophilic esophagitis is an effective yet poorly understood and underutilized treatment strategy. Despite several prospective trials demonstrating the efficacy of dietary therapies, successful clinical implementation is hampered by the need for a multidisciplinary approach including dietitian support and provider expertise. The availability of these resources is not readily available to most gastroenterologists. Without standardized guidance on starting or completing the diet for gastrointestinal providers and/or consulting dietitians, provider attitudes toward dietary therapy vary greatly depending on familiarity and knowledge gaps in using diet therapy. This review aims to summarize evidence in support of dietary therapy in eosinophilic esophagitis while providing guidance on initiation and implementation of dietary therapy for providers. Dietary therapy for short- and long-term management of eosinophilic esophagitis is an effective yet poorly understood and underutilized treatment strategy. Despite several prospective trials demonstrating the efficacy of dietary therapies, successful clinical implementation is hampered by the need for a multidisciplinary approach including dietitian support and provider expertise. The availability of these resources is not readily available to most gastroenterologists. Without standardized guidance on starting or completing the diet for gastrointestinal providers and/or consulting dietitians, provider attitudes toward dietary therapy vary greatly depending on familiarity and knowledge gaps in using diet therapy. This review aims to summarize evidence in support of dietary therapy in eosinophilic esophagitis while providing guidance on initiation and implementation of dietary therapy for providers. Eosinophilic esophagitis (EoE) is a chronic inflammatory immune-mediated disease affecting both children and adults, characterized by symptoms of esophageal dysfunction, eosinophilia, and fibrosis of the esophagus. A diagnosis of EoE is made based on symptoms such as dysphagia, food bolus obstruction, and less commonly heartburn, globus, or poor feeding; endoscopic mucosal findings of longitudinal furrows, rings, and strictures; and the presence of esophageal eosinophilia (>15 eosinophils per high-power field [eos/hpf]).1Furuta G.T. Liacouras C.A. Collins M.H. et al.Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment.Gastroenterology. 2007; 133: 1342-1363Abstract Full Text Full Text PDF PubMed Scopus (1407) Google Scholar, 2Dellon E.S. Gonsalves N. Hirano I. et al.ACG clinical guideline: evidence based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE).Am J Gastroenterol. 2013; 108: 679-692Crossref PubMed Scopus (846) Google Scholar, 3Lucendo A.J. Molina-Infante J. Arias A. et al.Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults.United European Gastroenterol J. 2017; 5: 335-358Crossref PubMed Scopus (619) Google Scholar This eosinophil-predominant inflammation characteristic of EoE is driven and precipitated by food antigens as affirmed by effective treatment of the disease with diet elimination of specific food allergens.4Markowitz J.E. Spergel J.M. Ruchelli E. et al.Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents.Am J Gastroenterol. 2003; 98: 777-782Crossref PubMed Scopus (512) Google Scholar, 5Kagalwalla A.F. Sentongo T.A. Ritz S. et al.Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis.Clin Gastroenterol Hepatol. 2006; 4: 1097-1102Abstract Full Text Full Text PDF PubMed Scopus (601) Google Scholar, 6Spergel J.M. Brown-Whitehorn T.F. Cianferoni A. et al.Identification of causative foods in children with eosinophilic esophagitis t","journal":"Clinical Gastroenterology and Hepatology","year":2023,"id":322959,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":38,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.957,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":663134,"name":"Kara Kliewer","orcid":"0000-0001-5178-4261","position":1,"is_corresponding":false},{"id":539924,"name":"Emily Haller","orcid":null,"position":2,"is_corresponding":false},{"id":1037636,"name":"Amanda Lynett","orcid":null,"position":3,"is_corresponding":false},{"id":1037637,"name":"Bethany Doerfler","orcid":null,"position":4,"is_corresponding":false},{"id":332488,"name":"David A. 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