Digestive Diseases and Sciences

, Volume 63, Issue 7, pp 1756–1762 | Cite as

Assessing Adherence and Barriers to Long-Term Elimination Diet Therapy in Adults with Eosinophilic Esophagitis

  • Ryan Wang
  • Ikuo Hirano
  • Bethany Doerfler
  • Angelika Zalewski
  • Nirmala Gonsalves
  • Tiffany Taft
Original Article



The six-food elimination diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients’ quality of life.


Assess patients’ long-term adherence to SFED and potential factors influencing adherence.


EoE patients were recruited online via multiple platforms. Patients were classified as reaching the maintenance stage if they responded to SFED and identified specific trigger foods by reintroduction. Maintenance stage patients were categorized into those actively following the elimination diet (ACTIVE) and those no longer on their prescribed diet (FORMER). Participants completed a study-specific questionnaire assessing patient experiences related to SFED use.


Forty-two participants were identified as having reached the SFED’s maintenance stage. 57% (24/42) of the maintenance stage patients were ACTIVE users. FORMER users rated the SFED’s effectiveness at treating symptoms (5.45 ± 3.96, 10 max.) lower than ACTIVE users (8.29 ± 2.76, p = .02). A greater percentage of FORMER users (100%) agreed social situations create challenges in following the diet compared to ACTIVE users (67%, p < .05). Anxiety related to SFED was also higher among FORMER users (64%) compared to ACTIVE users (21%, p < .01). Both ACTIVE (95.8%) and FORMER (81.8%, NSS) users would recommend the elimination diet to other EoE patients.


Understanding SFED adherence is multifactorial and complex. Factors influencing SFED adherence during long-term maintenance with diet therapy include diet effectiveness, social situations, and diet-related anxiety. Despite a lower than expected long-term adherence to maintenance of an elimination diet, the majority would recommend diet therapy as a treatment to other EoE patients.


Eosinophilic esophagitis Gastroesophageal reflux disease Dysphagia Food allergy Esophageal stricture Esophagitis 



Eosinophilic esophagitis


Eosinophils/high-power field


Gastroesophageal reflux disease


Proton pump inhibitor



Dr. Hirano would like to acknowledge grant support from the NIH Consortium of Eosinophilic Gastrointestinal disease Researchers (NIH U54AI117804), which is part of the Rare Disease Clinical Research Network, an initiative of the Office of Rare Disease Research funded through a collaboration between NIAID, NIDDK and NCATS.

Author contributions

RW and IH helped in project conception, study design, data collection/interpretation, data analysis, manuscript drafting, and critical revision; BD, AZ, and NG contributed to study design and critical revision; TT helped in project conception, study design, data collection/interpretation, data analysis, manuscript drafting, supervision, and critical revision.

Compliance with ethical standards

Conflict of interest

None of the authors have potential conflicts related to this manuscript. Ikuo Hirano is a consultant and has received research funding from Adare, Shire, Regeneron, and Receptos. Tiffany Taft has served as a speaker for Janssen and Abbvie and Bethany Doerfler for Nutricia North America and Allergan’s IBS counsel.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ryan Wang
    • 1
  • Ikuo Hirano
    • 1
  • Bethany Doerfler
    • 1
  • Angelika Zalewski
    • 1
  • Nirmala Gonsalves
    • 1
  • Tiffany Taft
    • 1
  1. 1.Division of GastroenterologyNorthwestern University Feinberg School of MedicineChicagoUSA

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