Six-food elimination diet improves symptoms of eosinophilic esophagitis

Dietary elimination with specific food trigger identification may be used in place of medical therapy for the treatment of adults with eosinophilic esophagitis (EoE), an immune-mediated inflammatory condition with tissue eosinophilia resulting in esophageal dysfunction, suggests a study.

A team of investigators completed a retrospective review (2006‒2021) of adults with EoE from an academic centre and classified patients as full responders (<15 eosinophils per high-power field [eos/hpf]) after completing the six-food elimination diet (SFED), an EoE treatment approach that removes milk, wheat, soy, eggs, tree nuts/peanuts, and fish/shellfish.

Food triggers identified were recorded in case of reintroduction.

Of the 213 patients who completed SFED, 115 (54 percent) had response <15 eos/hpf. Among the responders, 77 percent had improved symptoms. On the other hand, 32 percent of initial nonresponders underwent repeat dietary elimination.

More than half of the patients (n=123, 58 percent) achieved <15 eos/hpf after an initial or an extended SFED. Of the responders, 78 percent pursued food reintroduction. Of note, 69 percent of these patients had one food trigger identified, 24 percent had two allergens, and 4 percent had three allergens. Milk, wheat, and soy were the most common food triggers.

“The overall SFED histologic response was 54 percent, which increased to 58 percent with one additional round of dietary therapy, suggesting that 31 percent may respond in a second attempt,” the investigators said. “Most patients who completed food reintroduction had a single food trigger identified.”