Milk elimination diet effective for EoE in children
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More than half of pediatric patients with eosinophilic esophagitis experienced histologic remission after going on a milk elimination diet, according to study results.
Amir F. Kagalwalla, MBBS, from Ann & Robert H. Lurie Children’s Hospital of Chicago, and colleagues wrote that although six-food elimination diets have shown efficacy in EoE, they can be challenging for patients.
“We and others have identified cow’s milk protein [CMP] as the most common identified trigger of eosinophilia,” they wrote. “However, prior studies were limited by retrospective design, small sample size or age restrictions, and may not have accurately estimated efficacy from selection bias.”
Researchers conducted a prospective observational study in children with EoE who underwent treatment with a one-food elimination diet (1FED) that excluded all CMP. Dieticians helped educated children and their caregivers about dietary elimination of all CMP-containing foods, as well as substitutions that could help meet nutritional needs for optimal growth, development and daily meal planning.
Patients (n = 41) underwent upper endoscopy with biopsies after 8 to 12 weeks of treatment. The primary endpoint of the study was histologic remission, defined as less than 15 eosinophils per high-power field.
Kagalwalla and colleagues found that histologic remission occurred in 21 children (51%) and observed a decrease in eosinophils per high-power field (median 50 to1; P < .0001).
In all, 24 patients saw improvements to endoscopic abnormalities and 25 experienced symptom improvement, including improvements in chest pain and dysphagia.
Although parents perceived worse quality of life, their children thought the 1FED improved QOL.
“Notably 1FED does not require food reintroduction, thus transition to maintenance occurs more quickly without additional endoscopy,” Kagalwalla said. “This has significant implications on the standard of care, and further studies could assess the optimal ‘step-up’ approach, which has previously demonstrated to be feasible in adults. Our results provide evidence that CMP elimination can be offered as an alternative to other elimination diets as first-line treatment for EoE.”
Perspective
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Scott Gabbard, MD
This study evaluated a single food elimination diet of milk for children with EoE, with eosinophilia persisting despite PPI. The authors found that milk elimination resulted in about a 50% responder rate, defined as eosinophil count less than 15/hpf; about 40% of participants had an eosinophil count less than 6/hpf. Responders tended to be older than non-responders.
The option of a single food elimination diet is intriguing. While the long-term impact of a milk elimination diet was not studied, it does offer a potential simplified approach to dietary management of eosinophilic esophagitis in children. One could consider recommending a step-up approach to diet management, starting with milk only, and eliminating other food groups if needed. This contrasts to the classic approach of starting with a six-food elimination diet and adding back food groups as able. Any effort to simplify the dietary approach to eosinophilic esophagitis is certainly welcomed.
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