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 12 December 2017

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News

Efficacy of a food elimination diet for children with eosinophilic esophagitis

An observational outcome study reported in this month's Clinical Gastroenterology & Hepaotlogy examines eosinophilic esophagitis in children treated with dietary exclusion of cow's milk, wheat, egg, and soy.

News image

A 6-food elimination diet induces remission in most children and adults with eosinophilic esophagitis.

The effectiveness of empiric elimination of only 4 foods has not been studied in children.

Dr Amir Kagalwalla and colleagues from Illinois, USA performed a prospective observational outcome study in children with eosinophilic esophagitis treated with dietary exclusion of cow's milk, wheat, egg, and soy.

The team assessed the clinical, endoscopic, and histologic efficacy of this treatment in eosinophilic esophagitis.

The researchers recruited children from 4 medical centers.

Study participants were given a proton pump inhibitor twice daily and underwent a baseline esophagogastroduodenoscopy.

64% of subjects were in histologic remission after the elimination  diet
Clinical Gastroenterology & Hepatology

The team instructed subjects on dietary exclusion of cow's milk, wheat, egg, and soy.

Clinical, endoscopic, and histologic assessments were made after 8 weeks.

Responders had single foods reintroduced for 8 weeks, with repeat endoscopy to assess for recurrence of active disease.

The team's primary endpoint was histologic remission.

Secondary endpoints included symptom and endoscopic improvements and identification of foods associated with active histologic disease.

After 8 weeks on 4-food elimination diet, the team observed that 64% of subjects were in histologic remission.

The subjects' mean baseline clinical symptoms score was 4.5, which decreased to 2.3 after 8 weeks of 4-food elimination diet.

The mean endoscopic baseline score was 2.1, which decreased to 1.3.

The team found that after food reintroduction, the most common food triggers that induced histologic inflammation were cow's milk, egg, wheat, and soy.

One food trigger that induced recurrence of esophageal inflammation was identified in 62% of patients and cow's milk–induced eosinophilic esophagitis was present in 88% of these patients.

Dr Kagalwalla's team concludes, "In a prospective study of children with eosinophilic esophagitis, 8 weeks of 4-food elimination diet induced clinical, endoscopic, and histologic remission in more than 60% of children with eosinophilic esophagitis."

"Although less restrictive than 6-food elimination diet, 4-food elimination diet was nearly as effective, and can be recommended as a treatment for children with eosinophilic esophagitis."

Clin Gastroenterol Hepatol 2017: 15(11):  1698–1707.e7
06 November 2017

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