Trigger-Food Elimination Diets Are Effective for Patients With Eosinophilic Esophagitis

Trigger-Food Elimination Diets Are Effective for Patients With Eosinophilic Esophagitis

Prateek Sharma, MD, FASGE, reviewing Zalewski A, et al. Am J Gastroenterol 2022 Aug 12.

One treatment method for patients with eosinophilic esophagitis (EoE) is the six-food elimination diet (SFED), which removes milk, wheat, soy, egg, tree nuts/peanuts, and fish/shellfish from the patient’s diet. Foods are then gradually reintroduced to determine whether any of the removed foods are the trigger food for that patient. 

This retrospective study (2006-2021) included 213 patients who completed the elimination diet. Of the patients, 62% had a histologic response, and 77% of responders had symptom improvement after completion of the SFED. With the initial SFED, 54% (n=115) achieved <15 eosinophils per high-power field (responders), which increased to 58% (n=123) after an extended SFED. The Eosinophilic Esophagitis Endoscopic Reference Score improved in responders (mean score improved from 3.6 to 2.4; P<.05), whereas the score worsened for nonresponders (mean score worsened from 3.8 to 4.4; P=.06). Of the 78% of responders who underwent food reintroduction, the majority of patients (69%) had just one food trigger identified during the food reintroduction process. The most common food identified was dairy (37%), followed by wheat (26%), soy (13%), egg (10%), nuts (6%), seafood (4%), corn (1%), and poultry (1%).

Prateek Sharma, MD, FASGE


Approximately two-thirds of adult patients with EoE can have an effective response with a six-food elimination diet. The additional one-third of patients who don’t initially respond may respond with a second attempt at an elimination diet. Nearly 70% of patients with EoE will have just one food trigger identified. Endoscopic improvements were also noted with elimination diets.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Zalewski A, Doerfler B, Krause A, Hirano I, Gonsalves N. Long term outcomes of the six food elimination diet and food reintroduction in a large cohort of adults with eosinophilic esophagitis. Am J Gastroenterol 2022 Aug 12. (Epub ahead of print) (

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