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J Allergy Clin Immunol. 2014 Nov;134(5):1093-9.e1. doi: 10.1016/j.jaci.2014.07.023. Epub 2014 Aug 28.

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study.

Author information

1
Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. Electronic address: xavi_molina@hotmail.com.
2
Research Support Unit, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
3
Department of Gastroenterology, Hospital Rio Hortega, Valladolid, Spain.
4
Department of Gastroenterology, Hospital General Universitario Ciudad Real, Ciudad Real, Spain.
5
Department of Gastoenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.

Abstract

BACKGROUND:

Eosinophilic esophagitis (EoE) is an esophageal disorder predominantly triggered by food antigens. A six-food group elimination diet (SFGED) achieves remission in more than 70% of adult patients with EoE. After individual food reintroduction, just 1 or 2 food triggers for EoE can be identified in 65% to 85% of the patients, so some dietary restrictions and endoscopies after food challenge may be unnecessary.

OBJECTIVE:

To evaluate the efficacy of a four-food group elimination diet (FFGED) (dairy products, wheat, egg, and legumes) for adult patients with EoE.

METHODS:

Prospective multicenter study. All patients were reevaluated after 6 weeks on an FFGED. Response to the FFGED was defined by clinical and histologic (<15 eos/hpf) remission. Responders underwent reintroduction of each individual food over 6 weeks followed by endoscopy and esophageal biopsies. Nonresponders were offered a rescue SFGED.

RESULTS:

A total of 52 adult patients were included, of whom 12 patients (23%) had previous failure to topical steroid therapy. Twenty-eight of the 52 patients (54%) achieved clinicopathologic remission on the FFGED and 6 of the 19 (31%) nonresponders to the FFGED were successfully rescued with the SFGED. Twenty-two of 28 responders to the FFGED (78%) finished the individual food reintroduction challenge. Milk was identified as an EoE trigger in 11 patients (50%), egg in 8 (36%), wheat in 7 (31%), and legumes in 4 (18%). All patients had just 1 or 2 food triggers, with milk being the only causative food in 27% of the patients.

CONCLUSIONS:

An FFGED achieved clinicopathologic remission in 54% of adult patients with EoE. An SFGED was effective in almost a third of FFGED nonresponders, resulting in a combined efficacy of 72% of both strategies.

KEYWORDS:

Eosinophilic esophagitis; diet; four-food elimination diet; six-food elimination diet; treatment

PMID:
25174868
DOI:
10.1016/j.jaci.2014.07.023
[Indexed for MEDLINE]

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