Elimination Diets for Eosinophilic Esophagitis

How an EoE Elimination Diet Works

• Step 1 Cut out the specified food groups (either two, four, or six food groups — or even one only). Keep a food and symptom journal to monitor how it goes.
• Step 2 After six to eight weeks, undergo an endoscopy and a biopsy of the lining of the esophagus to get a baseline measurement of inflammation and other signs of EoE.
• Step 3 Slowly reintroduce one food group back into the diet. Continue to keep a food and symptom journal to track how you’re doing.
• Step 4 After two to four weeks, have another biopsy or an upper endoscopy (an esophagogastroduodenoscopy) to look for signs of inflammation. If there is no evidence of inflammation, the food likely is not a trigger, which means you can keep it in your regular diet.

Going forward, you’ll repeat steps 3 and 4 until you’ve tested all the food groups and, hopefully, identified a trigger.

There’s no question it can be tedious. “With the SFGED, there are more than 60 different food combinations you could have as triggers, so we have to do it very systematically,” Dr. Sauer explains.

Even so, “Many people with EoE have more than one dietary trigger,” says Sameer Berry, MD, a gastroenterologist at NYU Langone Health in New York City. “Don’t assume all other foods are safe once one trigger has been discovered.”

Not to mention, “You truly have to be all-in during the diet,” says Sauer. “You have to be as close to 100 percent compliant as you can — packing your own lunches, not eating out much or at all, and making other sacrifices.”

So it’s important to work with your doctor to come up with the right elimination diet approach for you.