Elimination diet is an effective treatment for eosinophilic esophagitis (EoE) and offers patients a drug-free alternative to controlling their disease. However implementing dietary therapy — including careful elimination and systematic reintroduction of potential trigger foods — can be challenging for both patients and clinicians.
A new guide published in CGH aims to summarize the evidence in support of elimination diets and provides a 50-page dietary resource to help providers successfully implement dietary therapies for EoE.
- Dietary therapy for EoE can be an effective first-line treatment to control eosinophilic inflammation and prevent complications.
- Despite the perceived challenges of dietary therapies, this approach is increasing in popularity among patients and ought to be considered when engaging in shared decision making for treatment choices.
- EoE dietary therapy involves identifying food triggers through an
- Empiric elimination phase with confirmed disease remission
- Food reintroduction phases to isolate food triggers that precipitate active disease and
- Long-term maintenance phase or avoidance of food triggers.
- Several dietary strategies can be offered, from more restrictive 6-food diet to less restrictive 2-food or 1-food elimination diets.
- Reintroduction phases to identify the specific food triggers by endoscopy with biopsy are just as important as the initial elimination phase.
- Clinicians should carefully consider patient motivation, preferences, age, life stage and nutritional status when selecting candidates for dietary therapy.
- Dietary resources provided in this review (Supplemental Materials) include education on label reading, foods to avoid, food substitutions, sample menus, how to implement reintroduction phases, practical tips for patients and online resources.