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Step-up diet: Less-intensive way to ID eosinophilic esophagitis food triggers?

EXPERT ANALYSIS FROM DIGESTIVE DISEASES: NEW ADVANCES

– While traditional elimination diets for eosinophilic esophagitis are highly restrictive and endoscopically intensive, a new “step-up” approach may offer a superior empiric scheme for identifying food triggers, according to Stuart J. Spechler, MD.

The recently described step-up approach may be preferable to the standard empiric six-food elimination diet, which has a 72% success rate but is challenging to implement, according to Dr. Spechler, chief of the division of gastroenterology, Baylor University Medical Center at Dallas.

Andrew D. Bowser/MDedge News
Dr. Stuart J. Spechler
In the standard elimination diet, the most common food allergens (milk, wheat, eggs, soy, nuts, seafood) are removed, and then reintroduced one at a time over 6 weeks, with symptom response assessment and repeat endoscopy after each introduction.

“That’s an extremely demanding, time-consuming, inconvenient, and expensive thing to do. It requires at least seven endoscopies, probably more, performed over a period of 42 weeks,” Dr. Spechler said here at Digestive Diseases: New Advances, jointly provided by Rutgers and Global Academy for Medical Education.