Corewell Health William Beaumont University Hospital Royal Oak, MI
Zain Ul Abideen, MBBS1, Usman Bin Hameed, MD2, Muhammad Hassan Waseem, MBBS3, Ammad Javaid. Chaudhary, MD4, Sania Aimen, MBBS5, Noor Ul Huda Ramzan, MD6, Fariha Hasan, MD7, Hafsa Shahid, MD8, Muhammad Shahzil, MD9, Mujtaba Moazzam, MD2, Samreen Zafar, MD10, Syed-Mohammed Jafri, MD4 1King Edward Medical University, Lahore, Punjab, Pakistan; 2Corewell Health William Beaumont University Hospital, Royal Oak, MI; 3Allama Iqbal Medical College, Lahore, Punjab, Pakistan; 4Henry Ford Health, Detroit, MI; 5Quetta Institute of Medical Sciences, Quetta, Balochistan, Pakistan; 6University of Texas Southwestern Medical Center, Dallas, TX; 7Cooper University Hospital, Camden, NJ; 8Brigham and Women's Hospital, Boston, MA; 9Penn State Health Milton S. Hershey Medical Center, Hershey, PA; 10Lake Huron Medical Center, Port Huron, MI Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the oesophagus often managed through dietary interventions. This systematic review and network meta-analysis compares the effectiveness of various elimination diets in treating EoE, aiming to identify the most effective dietary strategies for symptom management. Methods: PubMed, Cochrane Central and ScienceDirect were comprehensively searched from inception till January 2025 for studies comparing the elemental diet, one food elimination diet (OFED), four food elimination diet (FFED), FFED plus amino acids (FFED + AAF), six food elimination diet (SFED), and SFED plus amino acids (SFED + AAF). This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A frequentist network meta-analysis was performed using the R version 4.2.1 employing the “netmeta” package. Risk ratios (RR) with 95% Confidence intervals were pooled under the random effects model for the dichotomous outcomes. The primary outcome of interest was histological remission, defined as an eosinophil count ≤ 15. The ranking of the treatments was calculated using the p-scores. The risk of publication bias was assessed using the funnel plots, and the study quality was evaluated using the Cochrane RoB 2 tool for randomized controlled trials and the Newcastle Ottawa Scale (NOS) for observational studies. A Rank-heat plot was made to visualize the ranking of different diet regimens based on P-score. Results: Seven studies with a total of 567 patients were included in the final analysis. For the outcome of histological remission, FFED + AAF was ranked as the best treatment (p-score = 0.84), followed by elemental diet (p-score= 0.67) and OFED (p-score= 0.41). The SFED + AAF diet was ranked as the least favourable intervention for histological remission (pscore= 0.30). Discussion: The four-food elimination diet with amino acids (FFED + AAF) emerged as the most effective dietary intervention for achieving histological remission in eosinophilic esophagitis, followed by the elemental diet. In contrast, the six-food elimination diet with amino acids (SFED + AAF) was ranked as the least effective treatment.
Figure: Figure 1: (A) Network Plot for Histological Remission (B) Forest Plot for Histological Remission (C) League Table for Histological Remission in Patients with Eosinophilic Esophagitis
Figure: Figure 2: (A) Rank-Heat Plot for the Ranking of Different Dietary Interventions in Treatment of Eosinophilic Esophagitis (B) Funnel Plot for Histological Remission
Disclosures: Zain Ul Abideen indicated no relevant financial relationships. Usman Bin Hameed indicated no relevant financial relationships. Muhammad Hassan Waseem indicated no relevant financial relationships. Ammad Chaudhary indicated no relevant financial relationships. Sania Aimen indicated no relevant financial relationships. Noor Ul Huda Ramzan indicated no relevant financial relationships. Fariha Hasan indicated no relevant financial relationships. Hafsa Shahid indicated no relevant financial relationships. Muhammad Shahzil indicated no relevant financial relationships. Mujtaba Moazzam indicated no relevant financial relationships. Samreen Zafar indicated no relevant financial relationships. Syed-Mohammed Jafri: Abbvie – Speakers Bureau. Gilead – Speakers Bureau. Intercept – Speakers Bureau. Ironwood – Speakers Bureau. Takeda – Speakers Bureau.
Zain Ul Abideen, MBBS1, Usman Bin Hameed, MD2, Muhammad Hassan Waseem, MBBS3, Ammad Javaid. Chaudhary, MD4, Sania Aimen, MBBS5, Noor Ul Huda Ramzan, MD6, Fariha Hasan, MD7, Hafsa Shahid, MD8, Muhammad Shahzil, MD9, Mujtaba Moazzam, MD2, Samreen Zafar, MD10, Syed-Mohammed Jafri, MD4. P0612 - Comparing Different Elimination Diets in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
