Background: Several dietary approaches have been used to induce remission in patients with eosinophilic esophagitis (EoE), yielding varied results. Methods: We searched the MEDLINE, EMBASE, and Scopus databases up to May 2024 to identify studies including dietary interventions for EoE used as monotherapy. Summary estimates with 95% CIs for achieving <15 eosinophils/HPF were calculated for each approach. Fixed or random effects models were used depending on heterogeneity (I²); publication bias risks were assessed using funnel plot analyses. Subgroup analyses results were compared using meta-regression. Results: Forty-three studies with 2825 patients were included in quantitative summaries. The overall rate of histologic remission was 60.6% (95% CI, 54.6–66.5%). Effectiveness rates were 94.5% (95% CI, 92.3–96.4%) for elemental diets, 63.9% (95% CI, 58.5–69.2%) for six-food elimination diets, 54.7% (95% CI, 45.7–63.6%) for four-food elimination diets, 44.3% (95% CI, 36.1–52.8%) for two-food elimination diets, 46.4% (95% CI, 40–52.9%) for one-food elimination diets, and 39.5% (95% CI, 30.3–49.2%) for allergy testing-directed food elimination diets. Overall, superior efficacy was noted in children than in adults and in retrospective compared to prospective studies. Conclusion: Diet therapy remains an effective therapeutic asset for pediatric and adult patients with EoE, with increasing efficacy noted as the levels of dietary restriction increase.

Background: Non-alcoholic fatty liver disease (NAFLD) is a common concomitant condition in patients with inflammatory bowel disease (IBD). We aim to assess the magnitude of this association. Methods: We searched MEDLINE, EMBASE and Scopus libraries for the period up to February 2023 to identify studies reporting cohorts of IBD patients in which NALFLD was evaluated. Results: Eighty-nine studies were analyzed. The overall prevalence of NAFLD was 24.4% (95%CI, 19.3–29.8) in IBD, 20.2% (18.3–22.3) in Crohn’s disease and 18.5% (16.4–20.8) for ulcerative colitis. Higher prevalence was found in male compared to female patients, in full papers compared to abstracts, and in cross-sectional studies compared to prospective and retrospective ones. The prevalence of NAFLD in IBD has increased in studies published from 2015 onwards: 23.2% (21.5–24.9) vs. 17.8% (13.2–22.9). Diagnostic methods for NAFLD determined prevalence figures, being highest in patients assessed by controlled attenuation parameter (38.8%; 33.1–44.7) compared to ultrasonography (28.5%; 23.1–34.2) or other methods. The overall prevalence of fibrosis was 16.7% (12.2–21.7) but varied greatly according to the measurement method. Conclusion: One-quarter of patients with IBD might present with NAFLD worldwide. This proportion was higher in recent studies and in those that used current diagnostic methods.

Introduction: Eosinophilic esophagitis (EoE) has evolved from a rare condition to the leading cause of dysphagia and food impaction. This document (Part 1) provides an updated evidence‐based framework for the definition, epidemiology, natural history, and diagnosis of EoE in children and adults, updating the 2017 European evidence‐based guidelines. Methods: A panel of 32 experts from EUREOS, EAACI, ESPGHAN, and ESP developed these guidelines. Comprehensive literature searches were conducted (PubMed, Scopus, Embase, and Google Scholar) using the PICO framework. The GRADE methodology was applied to assess the certainty of evidence and strength of recommendations, while consensus was established via the Delphi method, requiring a minimum agreement threshold of 80%. Results: These guidelines characterize EoE as a heterogeneous condition driven by type 2 inflammation, with natural history influenced by diverse phenotypes and progression risks. EoE burden has risen sharply, with an annual incidence exceeding 10/100,000 and a pooled prevalence over 60/100,000, surpassing 160/100,000 in some regions. Diagnosis requires both symptoms of esophageal dysfunction and ≥ 15 eosinophils/hpf in esophageal mucosa, following the exclusion of alternative causes. EoE is clearly distinguished from asymptomatic esophageal eosinophilia. Key diagnostic recommendations include obtaining at least six biopsies from at least two esophageal levels, as endoscopic appearance alone lacks sufficient sensitivity. Gastric or duodenal biopsies are no longer mandatory unless driven by specific symptoms or endoscopic abnormalities at any point. Conclusions: These guidelines provide a robust clinical framework that reflects the increasing global prevalence of EoE and standardizes diagnostic criteria across all age groups to improve patient management.