Trigger-Food Elimination Diets Are Effective for Patients With Eosinophilic Esophagitis

One treatment method for patients with eosinophilic esophagitis (EoE) is the six-food elimination diet (SFED), which removes milk, wheat, soy, egg, tree nuts/peanuts, and fish/shellfish from the patient’s diet. Foods are then gradually reintroduced to determine whether any of the removed foods are the trigger food for that patient. 

This retrospective study (2006-2021) included 213 patients who completed the elimination diet. Of the patients, 62% had a histologic response, and 77% of responders had symptom improvement after completion of the SFED. With the initial SFED, 54% (n=115) achieved <15 eosinophils per high-power field (responders), which increased to 58% (n=123) after an extended SFED. The Eosinophilic Esophagitis Endoscopic Reference Score improved in responders (mean score improved from 3.6 to 2.4; P<.05), whereas the score worsened for nonresponders (mean score worsened from 3.8 to 4.4; P=.06). Of the 78% of responders who underwent food reintroduction, the majority of patients (69%) had just one food trigger identified during the food reintroduction process. The most common food identified was dairy (37%), followed by wheat (26%), soy (13%), egg (10%), nuts (6%), seafood (4%), corn (1%), and poultry (1%).