What is the role of dietary modifications in the treatment of esophagitis?

Updated: May 02, 2019
  • Author: Deepika Devuni, MBBS; Chief Editor: BS Anand, MD  more...
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A diet eliminating six food groups (six-food elimination diet [SFED]) that are likely to trigger allergies may help to ease the symptoms of eosinophilic esophagitis in adults, according to a study of 67 patients with active disease. [58, 59] The six food groups (cereals, milk, eggs, fish/seafood, legumes/peanuts, and soy) were eliminated and then reintroduced sequentially, one at a time. [6, 9]

Of the 67 patients in this study, 49 (73.1%) exhibited significant drops in peak eosinophil counts before foods were reintroduced. [58, 59] In all, 35.71% of the patients had one food trigger, 30.95% had two, and 33.3% had three or more. The most common food triggers, in descending order of frequency, were cow milk, wheat, eggs, and legumes. Patients who continued to avoid the allergy-triggering foods maintained a histopathologic and clinical remission for as long as 3 years.

In a cost utility analysis that compared the SFED with topical corticosteroids for first-line therapy of eosinophilic esophagitis, Cotton et al noted that although both therapies had similar efficacy, the six-food elimination diet was less expensive and more cost effective overall. [60]

In a study that evaluated patient-related costs for the SFED, Asher Wolf et al found that compared to an unrestricted diet, the cost of the SFED was higher ($92.54 vs $79.84, respectively; P = 0.0001) at a standard grocery store, and the SFED required the purchase of a higher proportion of items at another store (32% vs 3%, respectively; P = 0.0001). [61] The costs and number of items requiring a trip to a second store for both diets were similar when shopping at specialty grocery stores.

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