Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors

Background & Summary: Eosionophilic esophagistis is a condition in which the lining of the esophagus becomes inflamed and narrowed. Dysphagia, food impaction and heartburn are common symptoms. A diet eliminating wheat, milk, soy, egg, peanuts/tree nuts and fish/shellfish was found to be an effective treatment in pediatric patients. This study investigated the benefits of an elimination diet with adult patients. Fifty adults with confirmed esosinophilic esophagitis (biopsy of esophageal lining showed increased inflammatory markers) followed the elimination diet for six weeks. Thirty-five patients showed complete remission (based on post diet biopsy), 7 patients had partially remission and 8 patients did not respond. Dysphagia symptoms also significantly improved. The patients with complete remission introduced one eliminated food every two weeks. If symptoms returned, a biopsy was completed to confirm relapse. The trigger food was removed from the diet and no new foods were introduced for 6 weeks. Another biopsy was done to ensure remission before new foods were introduced. Trigger foods were identified in all patients that completed the food challenge phase. The most common foods to provoke symptoms were milk and wheat. In all patients, symptoms were evident within 5 days. Skin testing was completed prior to the study, but the results did not correlate with the food triggers identified through food challenge. Additionally, patients with confirmed food triggers did not report symptoms associated with these foods prior to the study.
Application to Dietetic Practice:  1) Dietitians can suggest that patients with symptoms suggestive of eosinophilic esophagitis speak with their physicians. 2) Results from this study and others can be used to advocate for dietary therapy in this condition. 3) Milk and wheat appear to be the most common food triggers (from this and other studies).
Pub Med ID: 22391333

Posted in: Fall2012-Research