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Your Guide to Eosinophilic Esophagitis

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Finding Eosinophilic Esophagitis Triggers with the Six Food Elimination Diet

Medically Reviewed By William C. Lloyd III, MD, FACS

Eosinophilic esophagitis, (EoE) causes inflammation in the esophagus, which can make it hard to swallow. And that can quickly become dangerous if you develop a food impaction, where food gets stuck in your narrowed esophagus. Avoiding certain foods that trigger the inflammation can make a big difference. You can figure out which foods to avoid by trying the eosinophilic esophagitis six food elimination diet.

Overhead view of brown-shell eggs in green container

The chronic inflammatory disorder known as eosinophilic esophagitis (EoE) can make mealtime an unpleasant experience. With EoE, you have an allergic reaction to certain foods you’re eating, which leads to inflammation in your esophagus, the tube that carries food from your mouth to your stomach. Medications are available to help ease EoE symptoms, but identifying the foods that trigger inflammation – and then avoiding them – is key. Your doctor may recommend you try the six food elimination diet, in which you temporarily stay away from the six types of food most commonly associated with EoE: dairy, wheat, soy, eggs, nuts, and seafood. With guidance from your doctor or a dietitian, you can determine the foods that activate your EoE.

Understanding the six food elimination diet

Your body’s immune response to certain foods may be the main cause of your eosinophilic esophagitis. However, these food allergies can be difficult to diagnose, since your reaction to the food allergen may be delayed. That makes it hard to figure out which food is the culprit.

You can accomplish that by removing the most common food allergens from your diet for 6 to 8 weeks before gradually reintroducing them, one at a time, for a 2-week trial.

The six types of food that you’ll temporarily avoid include:

  • milk and milk products
  • eggs
  • soy
  • wheat
  • fish and shellfish
  • peanuts and tree nuts

After 6 to 8 weeks without any of these food items, your doctor will monitor you for signs of inflammation. And after each food is reintroduced into your diet, you’ll return for more monitoring to see its effects. This will often entail a procedure called an esophagogastroduodenoscopy (EGD), in which your doctor will numb your throat and then insert an endoscope to look at the lining of your esophagus, your stomach, and your duodenum. Because of the need for repeated endoscopies, the doctor sometimes offers the chance to undergo other testing procedures, such as a transnasal endoscopy (TNE), in which the endoscope is inserted through the nose, or an esophageal string test (EST), which involves swallowing a gelatin capsule that’s attached to a string. Check with your doctor to see if any of the alternative tests are appropriate for you. You’ll also be instructed to track your food intake and symptoms during this process.

Once you know which foods seem to trigger your symptoms, you can permanently remove them from your diet. Your symptoms should start to improve within the next few weeks.

Navigating an elimination diet

It may seem daunting to eliminate certain foods from your diet. If you’re not already in the habit of carefully reading food labels, now’s the time to start. You want to make sure you’re not accidentally consuming food that contains something like milk or wheat, if you’re trying to eliminate those foods.

Talk to your doctor or your dietitian about what foods you can eat during the six food elimination diet to make sure you’re getting enough nutrients and calories to sustain you. Your doctor may also suggest taking a daily multivitamin while you’re working to figure out your triggers.

Also, let your doctor know if you get discouraged or run into any problems. The process can be challenging, but your doctor may be able to coach you through the process. If you’ve found the six food elimination diet too difficult to follow, ask your doctor about trying an alternative approach, called the step-up diet. It involves cutting out just two foods at first – usually dairy and wheat, since they are the most common food triggers for EoE. If your EoE symptoms don’t improve after 6 to 8 weeks, you’ll cut out two more food items, and then if that doesn’t help, you’ll end up removing all six food types from your diet temporarily.

Making changes to your diet can be overwhelming, but your doctor and dietitian are there to support you, and ultimately, you’ll learn what foods trigger your EoE symptoms. It’s a lot of work, but it’s worth it to feel well and enjoy your meals again.

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  1. Eosinophilic esophagitis. (2020).
  2. Eosinophilic esophagitis. (2021).
  3. Food elimination diet for eosinophilic esophagitis (EoE). (n.d.)
  4. Molina-Enfante J., et al. (2018). Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study.
  5. Nguyen N., et al. (2021). Endoscopy in pediatric eosinophilic esophagitis.
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2022 May 19
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