Eosinophilic esophagitis elimination diet

History:

The two food elimination diet (2FED) for eosinophilic esophagitis (EoE). EoE is a chronic disorder characterized by dysphagia, impaction, chest pain, and heartburn (1). To confirm the diagnosis of EoE an endoscopic biopsy from the esophageal mucosa is obtained. EoE is thought to be a food allergen-mediated disease of the esophagus as most patients respond well to elimination and elemental diets. EoE is a chronic disorder characterized by This diet eliminates two of the most common food allergens to decrease inflammation of the esophagus.

Purpose:

It is thought that by eliminating the most common food allergens from the diet esophageal inflammation will reduce and symptoms will improve.

General dietary practices:

The two-food elimination diet eliminates milk and wheat from the diet. This diet is then followed by an esophagogastroduodenoscopy (EGD) and esophageal biopsy six weeks after to examine the results of the diet. Responders of the diet will then have a new food group reintroduced every 2-4 weeks. To determine which foods are triggering the inflammation, esophageal histologic sampling is required during the reintroduction phase. Depending upon an individual's conditions they may choose to eliminate more than the six foods listed above.

Key concerns:

Initially, this diet is very restrictive making it hard to follow and may lead to long-term dietary limitations. There are no known associated health risks of the diet however due to its restrictive nature there are potential risks for nutrient deficiencies. Professional guidance is recommended when eliminating and reintroducing food groups. This diet was created for people with EoE, therefore is not advised for healthy individuals. Moreover, this diet may be costly during the first 6 months before evaluation with an EGD.

Further Resources:

Websites: 

**The information presented provides an overview of the diet along with credible resources to refer to in order to learn more. This is not intended to make any dietary recommendations, rather an education tool for our clients.**

Reference: 

  1. Use of dietary strategies in treating eosinophilic esophagitis - Mayo Clinic. Mayoclinic.org. https://www.mayoclinic.org/medical-professionals/digestive-diseases/news/use-of-dietary-strategies-in-treating-eoe/mac-20431442. Published 2017. Accessed July 26, 2020.