title: Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study.
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.
authors.affiliation: Department of Gastroenterology, Hospital San Pedro de Alcantara, Caceres, Spain. Electronic address: xavi_molina@hotmail.com.
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.affiliation: Research Support Unit, Hospital General Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Arias
authors.affiliation: Department of Gastroenterology, Hospital Rio Hortega, Valladolid, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Barrio
authors.affiliation: Department of Gastroenterology, Hospital General Universitario Ciudad Real, Ciudad Real, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Rodríguez-Sánchez
authors.affiliation: Department of Gastoenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sanchez-Cazalilla
authors.affiliation: Department of Gastoenterology, Hospital General de Tomelloso, Tomelloso, Ciudad Real, Spain.
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057765:Eosinophilic Esophagitis / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology; D005260:Female; D005512:Food Hypersensitivity / Q000178:diet therapy* / Q000276:immunology / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012074:Remission Induction
keywords: Eosinophilic esophagitis; diet; four-food elimination diet; six-food elimination diet; treatment