S387 Six Food Elimination Diet—Our Experience at a Tertiary Academic Center

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Introduction: The 6-food elimination diet (SFED) has been widely used for trigger food identification in Eosinophilic Esophagitis (EoE). Since the inception of SFED, other strategies have emerged including 1-food, 2-food, 4-food elimination diets, and the step-up approach. These other strategies have a lower histologic response rate, but quickly identifying responders allows for less endoscopies and dietary restriction. We aim to evaluate our success rate of SFED with a dedicated dietitian. Methods: Retrospective review of adult EoE patients who were referred for SFED initiation from 2018 to 2021. Demographic information, diet completion status, treatment duration, total number of EGDs, and trigger food were obtained. Fisher’s Exact for categorical variables or Wilcoxon rank sum for continuous variables were used for statistical analysis. Results: 78 patients were identified, with a mean (SD) age of 42 (15), 63% male, BMI 26 (5). Ten patients still undergoing the elimination or re-introduction process were excluded due to incomplete data. Of the 68 included patients, 17 (25%), a significantly younger (34 vs 44; P=0.008) group, decided to not pursue diet elimination, while 19 (28%) dropped out during diet, and 32 (47%) completed. Of the 51 patients who initiated SFED, mean (SD) treatment duration was 11 (10) months in those completed vs 6 (7) months in those dropped out. The number of EGDs was 4 (3) in the completed group vs 2 (1) in the dropout group. Men had a higher but nonsignificant dropout rate (13/32 vs 6/19, P=0.56). Of those who dropped out: 4 preferred pharmacologic therapies, 1 had severe dysphagia, 3 developed other medical conditions (malignancy or pregnancy), 1 had financial barriers, 1 moved out of state, 9 for unclear reasons. 3 of 19 dropouts were on extended 8-food elimination (8FED: SFED + corn and legume). Among the 32 patients who completed the process, 12 failed to identify the trigger (8/12 had trial of 8FED). The most common identified trigger foods were dairy in 17 patients and wheat in 11. Twenty- 2 patients had >1 trigger food. Conclusion: Our center’s experience shows a low completion rate of SFED. This is notable given our patients partnered with a dietitian. Younger age and male gender may be risk factors for not successfully completing SFED. This study highlights the ongoing need for shared decision-making with patients and that extended diet therapies are difficult. Further studies are needed to compare SFED efficacy with other simplified diet strategies.Table 1.: Demographics by Complete/Dropout Six Food Elimination Diet.

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