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Less restrictive elimination diet effective in children with EoE
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A less restrictive four-food elimination diet was almost as effective as a six-food elimination diet for treating children with eosinophilic esophagitis, according to new research.
In the prospective study, more than 60% of children achieved remission after avoiding cow’s milk, wheat, egg and soy for 8 weeks. In comparison, the standard six-food elimination diet approved to treat EoE — which also excludes peanuts and tree nuts, fish and shellfish — has been previously shown to induce remission in 58% to 81% of children and adults with EoE. Other studies have since suggested that the foods excluded in the four-food elimination diet are those most likely to cause inflammation in EoE.
“Excluding many foods from a child’s diet is a major challenge for families,” Amir F. Kagalwalla, MD, MBBS, co-director of the Eosinophilic Gastrointestinal Diseases Program at the Ann & Robert H. Lurie Children’s Hospital of Chicago and associate professor of pediatrics at Northwestern University Feinberg School of Medicine, said in a press release. “Our study shows that we can achieve nearly the same results with four instead of six foods that children with EoE need to avoid initially. Also, it takes much less time to reintroduce the foods and fewer endoscopies to determine which foods truly need to be avoided to maintain remission. These are huge benefits.”
Kagalwalla and colleagues evaluated 78 children with EoE (67% boys; mean age, 9.01 years; 83% white; 90% atopic) who adhered to the four-food elimination diet for 8 weeks, after which single foods were reintroduced in responders. All participants also received a PPI twice per day and underwent clinical, endoscopic and histologic assessments at baseline, after the dietary intervention, and again after food reintroduction to assess for disease recurrence.
The study met its primary endpoint with 64% of patients achieving histologic remission after 8 weeks of adhering to the diet. Participants also showed significant clinical and endoscopic improvements.
“All symptoms resolved in 36% of respondents and symptom score decreased in 91%,” Kagalwalla and colleagues wrote. Abdominal pain, poor appetite, vomiting, food impaction, choking or gagging, regurgitation, and pocketing or spitting out food all resolved in a significant number of responders.
Food reintroduction showed cow’s milk (85%) was the most common trigger of histological inflammation, followed by eggs (35%), wheat (33%) and soy (19%). Recurrent inflammation was induced by a single food trigger in 62% of patients, and cow’s milk was the single trigger in most of them (88%).
“The high percentage of children for whom milk was a trigger provides the basis for investigating a milk-only elimination diet approach,” Kagalwalla noted in the press release.
The investigators concluded that the four-food elimination diet induced “clinical remission in nine out of 10 histological respondents,” and histological remission “in more than six out of 10 children, which is nearly identical to remission with [the six-food elimination diet] but with a diet that is less stringent.”
These results show this diet “can be offered to children in preference to [the six-food elimination diet] and as an alternative to topical corticosteroid refractory patients for the treatment of EoE,” they wrote. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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