Elimination Diet Works for Eosinophilic Esophagitis in Adults

A six-food elimination diet led to symptom improvement in 94% of patients and complete histologic improvement in 64%.

Eosinophilic esophagitis (EoE) is increasingly recognized as a cause of dysphagia, food impaction, and heartburn. In children, a true elemental diet seems to be effective but is too unpalatable for routine use. A six-food elimination diet (milk, soy, egg, wheat, peanuts/tree nuts, and shellfish/fish) has shown moderate effectiveness in treating children with EoE but has not been well studied in adults.


In a single-center, prospective study, researchers recruited 50 adult patients with symptoms of dysphagia, heartburn, or food impaction and ?15 eosinophils per high-power field (eos/hpf) to receive treatment with the six-food elimination diet instead of topical corticosteroids. The diet lasted 6 weeks, at which point endoscopy with esophageal biopsies was conducted to measure the primary endpoint of complete histologic improvement (?5 eos/hpf). Subsequently, one food was reintroduced every 2 weeks, and endoscopy with biopsy was repeated every 4 weeks during that process.

Of the 20 patients who completed the elimination diet, the mean esophageal eosinophil count decreased from 34 to 8 eos/hpf in the proximal esophagus and from 48 to 13 eos/hpf in the distal esophagus (P<0.0001 for both). At diet completion, eosinophil counts were ?5 eos/hpf in 64% of patients and ?10 eos/hpf in 70%; reduction in eosinophil count was ?50% in 78% of patients. Dysphagia symptom scores decreased in 94%, and endoscopic features improved in 78%. Response was greatest in those with initial complaints of heartburn. After reintroduction of trigger foods, all patients showed symptom recurrence within 5 days (median, 3 days) and histologic recurrence. The most common food triggers were wheat (60%) and milk (50%), followed by soy (10%), nuts (10%), and egg (5%). Fifteen percent of patients had ?1 trigger. Skin-prick testing predicted only 13% of these triggers.


Citation(s):

Gonsalves N et al. Elimination diet effectively treats eosinophilic esophagitis in adults; Food reintroduction identifies causative factors. Gastroenterology 2012 Jun; 142:1451.