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Comment & Response
March 2019

A Case for n-of-1 Trials

Author Affiliations
  • 1Division of Geriatrics, Department of Medicine, University of California, San Francisco, San Francisco
  • 2San Francisco VA Medical Center, San Francisco, California
JAMA Intern Med. 2019;179(3):452-453. doi:10.1001/jamainternmed.2018.7183

To the Editor Several months ago, I began experiencing dysphagia and solid food impaction. Findings from an esophagogastroduodenoscopy (EGD) with biopsy confirmed eosinophilic esophagitis. My gastroenterologist recommended the 6-food elimination diet to eliminate milk products, wheat, soy, eggs, seafood, or nuts from my diet for 6 to 8 weeks until my symptoms resolved, then add them back 2 at a time until symptoms recurred.

This diet seemed draconian. Cruel even. And nearly impossible. I quickly reviewed the literature and found the 6-food elimination diet is indeed standard of care.1 Compliance with the 6-food elimination diet in real-world settings is understandably low. Some recommend repeat EGDs at each step of the elimination diet, for up to 5 EGDs per patient,2 at an immense burden to patients and expense to the health care system.

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