Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis.
OBJECTIVE
In children, eosinophilic esophagitis (EE) is predominantly, but not exclusively, a food-hypersensitivity disorder. A crystalline amino acid-based elemental diet (ELED) formula currently remains the most effective nutritional treatment in inducing clinical and histologic remission. However, compliance with an exclusive, poor-tasting liquid formulation is difficult.


METHODS
This retrospective observational study assessed the short-term clinical and histologic responses of 2 cohorts of children with EE evaluated during 2 different time periods: one was treated with the standard 6-food elimination diet (SFED) and the other was treated with ELED. Of the 60 children who met the inclusion criteria and were compliant with the dietary protocol, 35 were treated with a diet excluding cow-milk protein, soy, wheat, egg, peanut, and seafood while allowing all other table foods and 25 were treated exclusively with ELED. Repeat esophageal biopsy specimens were obtained at least 6 weeks later.


RESULTS
Twenty-six of 35 (74%) in the SFED group and 22 of 25 (88%) in the ELED group achieved significant improvement of esophageal inflammation (</=10 eosinophils/high-power field). The pretreatment and posttreatment peak eosinophil counts for the SFED were 80.2 +/- 44.0 and 13.6 +/- 23.8 (P < .0001) and 58.8 +/- 31.9 and 3.7 +/- 6.5 (P < .001) for the ELED group, respectively.


CONCLUSIONS
SFED treatment was associated with clinical and histologic improvement in EE in an observational study. It offers advantages of better acceptance, cost, and compliance than ELED and should be considered as an option in the initial management of children with EE.
Kagalwalla
Amir F
AF
Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. akagalwa@uic.edu
Sentongo
Timothy A
TA
Ritz
Sally
S
Hess
Therese
T
Nelson
Suzanne P
SP
Emerick
Karan M
KM
Melin-Aldana
Hector
H
Li
B U K
BU
D000293:Adolescent; D002648:Child; D004802:Eosinophilia / Q000178:diet therapy* / Q000473:pathology; D004941:Esophagitis / Q000178:diet therapy* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005526:Food, Formulated; D006801:Humans; D008297:Male; D010349:Patient Compliance; D012189:Retrospective Studies; D016896:Treatment Outcome