S845 Comparing Different Elimination Diets in the Treatment of Eosinophilic Esophagitis: A Systematic Review and Network Meta-Analysis

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus 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 until January 2025 for studies comparing the elemental diet, 1 food elimination diet (OFED), 4 food elimination diet (FFED), FFED plus amino acids (FFED + AAF), 6 food elimination diet (SFED), and SFED plus amino acids (SFED + AAF). This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 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 P-scores. The risk of publication bias was assessed using funnel plots, and the study quality was evaluated using the Cochrane Risk of Bias 2 tool for randomized controlled trials and the Newcastle Ottawa Scale 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 favorable intervention for histological remission (P-score = 0.30). Conclusion: The 4-food elimination diet with amino acids (FFED + AAF) emerged as the most effective dietary intervention for achieving histological remission in EoE, followed by the elemental diet. In contrast, the 6-food elimination diet with amino acids (SFED + AAF) was ranked as the least effective treatment.