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Elemental Diet Reduces Inflammation, Improves Symptoms in Adults with EoE
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An elemental diet reduced eosinophilic inflammation, improved symptoms and induced clinical remission in adults with eosinophilic esophagitis, according to prospective study data.
Investigators concluded the data “strongly suggests” elemental dietary management induces clinical remission in most adults with EoE, and appears “highly promising” in certain patients.
“In adult EoE patients, an elemental, amino acid-based diet induces a complete histological remission in 71% of the patients and induces clinical remission in more than 90% of the patients,” Marijn J. Warners, MD, PhD, of the department of gastroenterology and hepatology and the Tytgat Institute for Liver and GI Research at the Academic Medical Center, Amsterdam, Netherlands, told Healio Gastroenterology. “These results underline the importance of food allergens as a driver of EoE in adults.”
Marijn J. Warners
Because the effectiveness of elemental diets has primarily been demonstrated in children with EoE, Warners and colleagues performed a prospective study of a newly developed elemental diet (Neocate, Nutricia) in 21 adults with active EoE who were recruited between December 2014 and September 2015.
The investigators evaluated endoscopy findings and histological disease activity before patients began the diet and 4 weeks after. They also assessed symptoms and dietary adherence based on questionnaire responses, as well as serum total IgE levels, total eosinophil counts and inflammatory cytokine expression.
Seventeen of the patients completed the dietary intervention, 71% of whom had a complete histological response defined as fewer than 15 eosinophils per high-power field (HPF), and 24% of whom had a partial histological response defined as at least a 50% decrease in baseline eosinophil count.
“In addition, all complete responders also had a reduction of more than 50% of pre-diet eosinophil count,” the researchers wrote.
Peak eosinophil counts also dropped significantly after the dietary intervention from 40 eosinophils/HPF to 9 eosinophils/HPF (P < .001). Endoscopic features improved in 94% of patients, and overall endoscopic scores improved significantly after the diet (P < .001).
Further, all patients experienced a significant reduction in symptoms, with 88% becoming completely asymptomatic (P .001).
Finally, blood eosinophil counts and serum IgE levels decreased in 82% of patients (P .05).
“Additionally, with a relatively low drop-out rate, patient adherence to this diet is better than previously described,” Warners said. “The results of this prospective study imply that an elemental diet can be considered as first line treatment in motivated adult patients with EoE.” – by Adam Leitenberger
Disclosures: The study was partially funded by a grant from Nutricia Research. Warners reports no relevant financial disclosures. Please see the full study for a list of all other researchers’ relevant financial disclosures.
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