Esophagus to Small Intestine
Am J Gastroenterol. 2022;117(12):1963–70
Long-term outcomes of the six-food elimination diet and food reintroduction in a large cohort of adults with eosinophilic esophagitis
Introduction: Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory condition with tissue eosinophilia resulting in esophageal dysfunction. The six-food elimination diet (SFED) is an EoE treatment approach that removes milk, wheat, soy, eggs, tree nuts/peanuts, and fish/shellfish. After histologic remission, food reintroduction occurs to identify a food trigger. Outcomes from large series of adults undergoing SFED and food reintroduction as clinical care are not known.
Methods: A retrospective review (2006–2021) of adult patients with EoE from an academic center was completed. Patients were classified as full responders (< 15 eosinophils [eos]/high-power field [hpf]) after SFED. If reintroduction was pursued, food triggers identified were recorded.
Results: 213 patients completed SFED. 115 patients (54%) had response < 15 eos/hpf after SFED. 77% of responders had symptom improvement. 32% of initial non-responders underwent repeat dietary elimination. 58% of patients (n = 123) achieved < 15 eos/hpf after either initial or extended SFED. 78% of responders underwent food reintroduction. 69% had 1 food trigger identified, 24% had 2 allergens identified, and 4% had 3 allergens identified. The most common food triggers identified were milk, wheat, and soy.
Discussion: This study describes the largest cohort reported of adult patients with eosinophilic esophagitis (EoE) completing six-food elimination diet (SFED) with food reintroduction. The overall SFED histologic response was 54%, which increased to 58% with 1 additional round of dietary therapy, suggesting that 31% may respond in a second attempt. Most patients who completed food reintroduction had a single food trigger identified. Dietary elimination with specific food trigger identification is a feasible alternative to medical therapy for adults with EoE.