A six-food elimination diet significantly improves symptoms in adult patients with eosinophilic esophagitis (EoE), according to a new study in Gastroenterology, the official journal of the American Gastroenterological Association. In EoE, eosinophils and other inflammatory cells cause inflammation of the esophagus in response to an allergic stimulus. Previously thought to be a rare disease, EoE has become one of the most common causes for dysphagia (difficulty swallowing), heartburn and the sensation of “food stuck in the throat” in adults. Similar to children, this study has now shown that food allergens have a causative role in the majority of adults with EoE.
An elimination diet that identifies specific food triggers is an effective therapeutic alternative to corticosteroids for adults with EoE. Furthermore, the results of a reintroduction process in which these trigger foods are added back into a patient’s diet support the fact that food antigens are driving this response; this provides new insight into the nature of the inflammatory response in adult EoE.
“By first eliminating, then systematically reintroducing foods in our adult patients, we were able to identify the specific food triggers that caused their symptoms, such as heartburn, chest pain and difficulty swallowing, or the sensation of food being stuck in their throat,” said Nirmala Gonsalves, MD, of Northwestern University and the lead author of this study. “Given the poor sensitivity of skin prick testing and lack of history of food allergy or intolerance, the six-food elimination diet with reintroduction is the only reliable method to date to identify food triggers in adult eosinophilic esophagitis and should allow us to better tailor diet to individual patients for long-term management.” View a video abstract in which Dr. Gonsalves discusses her study findings.
A diet that eliminates all of the six most commonly allergenic foods (milk, soy, egg, wheat, peanuts/tree nuts and shellfish/fish) significantly improves symptoms and reduces esophageal tissue damage associated with EoE in adults. In fact, 78 percent of patients achieved greater than a 50 percent reduction in peak eosinophil (white blood cell) counts in their esophagus; dysphagia symptom scores improved significantly after the elimination diet. Once trigger foods were reintroduced, all patients had recurrence of their symptoms within five days. These results suggest that EoE is likely the same disease in children and adults.
