Efficacy of a Dairy‐Free Diet in Adult Patients With Eosinophilic Esophagitis: A Pilot Prospective Multicenter Study

Background: Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease in which elimination diets represent an effective therapeutic option. Although six-food elimination diets (6-FED) achieve high remission rates, their complexity often compromises adherence. Dairy-free diet (DFD) has emerged as a simpler alternative, yet evidence in adult populations remains limited. Aims: To evaluate the clinical, endoscopic, and histological outcomes of a 12-week DFD in adult patients with EoE and to explore potential predictors of histological remission and dietary adherence. Methods: We conducted a prospective, multicenter, open label, single-arm interventional study across five Italian referral centers, enrolling 31 adults with active EoE. Participants followed a 12-week DFD, after which clinical symptoms (EEsAI), disease severity (I-SEE), endoscopic findings (EREFS), quality of life (EoE-QOL-A), and adherence (VAS scale) were assessed. Results: Twenty-eight patients completed the 12-week protocol. Histological remission was achieved in 53.6% of patients (intention-to-treat: 48.4%); among these, 86.7% also reached clinical remission. The median EEsAI improved from 35 to 18.5 (p = 0.009) and the median I-SEE score from 6.5 to 4 (p < 0.0001). Quality of life improved (median EoE-QoL-A from 36.5 to 52, p = 0.02), and adherence was high (median VAS 8 [IQR 7–9.5]). Predictors of lower histological response included previous esophageal dilations and higher baseline exudate and eosinophil counts. Male sex and higher BMI predicted lower adherence. Conclusions: In this exploratory multicenter prospective study, DFD induced histological remission in more than half of patients and clinically meaningful improvements in symptoms, disease severity, endoscopy, and quality of life.