The limitations in the current literature make it difficult to have any firm statement on the effects of food-elimination diets versus no diet. One higher quality RCT compared 1-food elimination diet to 6-food elimination diet and found no benefit in eosinophilic counts, but the results were imprecise (Change difference 0.72 [0.43 – 1.20], favoring 6FED).
| Reference | Study type | Population | Intervention and comparison | Outcomes | Risk of bias |
|---|---|---|---|---|---|
| RCT=randomized controlled trial; SR=systematic review; MA=meta-analysis | |||||
| «Kliewer K, Aceves SS, Atkins D ym. 817 – Efficacy ...»1 | RCT | Adults with active and symptomatic EoE | 1FED (animal milk) vs 6FED (animal milk, wheat, egg, soy, fish, shellfish, peanut and tree nuts) | Peak eosinophil count at 6 weeks | moderate |
| «Mayerhofer C, Kavallar AM, Aldrian D, ym. Efficacy...»2 | Systematic review and meta-analysis | Adults and children with active EoE | 1-6 Food elimination diets. Most studies with no control group. | Histologic remission (15 or fewer eosinophils per HPF) | high |
| Reference | Comments |
|---|---|
| «Kliewer K, Aceves SS, Atkins D ym. 817 – Efficacy ...»1 | Randomisation and allocation concealment ok, study investigators and patients were not blinded, very little missing data (5/129). ITT analysis. |
| «Mayerhofer C, Kavallar AM, Aldrian D, ym. Efficacy...»2 | Comprehensive systematic search strategy. 30/34 were observational studies from which most did not have comparison groups. Study quality by the authors: quality assessment median score 7/10, Risk of bias was low in 4 studies, moderate in 26 and serious in 4 studies. |
| Reference | Number of patients (I/C) | Follow-up time | Intervention group mean | Control group mean | Relative effect (95% CI) |
|---|---|---|---|---|---|
| I= intervention; C=comparison; CI=confidence interval | |||||
| 1. Peak eosinophil count | I 62 / C 67 | 6 weeks | Baseline: 38.4 (95% CI 32.8 – 44.9) Follow up: 10.9 (7.3 – 16.5) |
Baseline: 50.3 (95% CI 42.2 – 60.0) Follow up: 20.8 (15.0 – 28.9) |
Change difference 0.72 (0.43 – 1.20) (in favor of intervention) |
| 2. Histologic remission | 34 studies with 1762 patiens; 701 in 6FED, 302 in 4FED, 306 in 1FED, 453 in targeted FED |
Median 6 weeks (IQR 6-8) | Follow up: 6FED: 61.3% (95% CI 53.0% - 69.3%), 4FED: 49.4% (95% CI 32.5% - 66.3%), 1FED: 51.4% (42.6% - 60.1%) tFED: 45.7% (32.0% - 59.7%) |
- | - |
| Level of evidence: very low The quality of evidence is downgraded due to study limitations, inconsistency, indirectness, imprecision, and risk of bias. |
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