6-food elimination diet may work for more than half of patients with eosinophilic esophagitis
Removing milk, wheat, soy, eggs, tree nuts/peanuts, and fish/shellfish from one's diet and then gradually reintroducing these food categories identified a single food trigger for 69% of participating patients with eosinophilic esophagitis, a retrospective study found.
A retrospective study of adults who had undergone an empiric elimination diet for eosinophilic esophagitis showed that the majority (58%) achieved histologic response.
The six-food elimination diet (SFED) is an eosinophilic esophagitis treatment that removes milk, wheat, soy, eggs, tree nuts/peanuts, and fish/shellfish and reintroduces them after histologic remission to identify a food trigger. Researchers conducted a retrospective review from 2006 to 2021 of adult eosinophilic esophagitis patients from an academic center, classifying them as full responders if they had less than 15 eosinophils per high-power field after the SFED. If reintroduction occurred, identified food triggers were recorded. Results were published by the American Journal of Gastroenterology on Aug. 12.
Two hundred thirteen patients completed SFED, and 115 (54%) were full responders, 77% of whom had symptom improvement. Also, 32% of initial nonresponders underwent repeat diet elimination, raising the total of full responders to 123 (58%) after either initial or extended SFED. A total of 78% of responders underwent food reintroduction, with 69% having one food trigger identified, 24% two, and 4% three. Milk, wheat, and soy were the most common triggers.
The researchers stated that targeted dietary elimination is a feasible alternative to medical therapy for adults with eosinophilic esophagitis, even in general clinical practice and not as part of a trial. Still, they noted that the study was done at a dedicated center with special interest in dietary therapy and dietary services, so the approach may not be generalizable.
“We acknowledge that dietary therapy is challenging both from a practitioner and patient standpoint as there is more effort needed to achieve a desirable outcome compared to medical therapy,” they wrote. “Our center is keenly interested in this approach as our patients have been very active in pursuing non-pharmacologic alternatives to treatment, so our practice has evolved to include this as a treatment plan.”