Elimination Diet Can Treat Eosinophilic Esophagitis in Adults
(HealthDay News) – A six-food elimination diet can successfully treat adults with eosinophilic esophagitis (EoE).
Nirmala Gonsalves, MD, of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a study involving 50 adults with EoE who were treated with a six-food elimination diet (SFED) for six weeks. The foods eliminated were: milk, soy, egg, wheat, peanuts/tree nuts, and shellfish/fish. Participants underwent esophagogastroduodenoscopy (EGD), biopsies, and skin-prick tests before treatment. Histologic response was defined as having ≤5 eosinophils per high-power field (eos/hpf), and responders underwent systematic reintroduction of food, after which, EGD and biopsies were repeated.
The researchers found that 96, 74, and 94% of participants experienced dysphagia, food impaction, and heartburn, respectively. In the proximal and distal esophagus, there was a significant reduction in the peak eosinophil count after SFED (from 34 to 8 and from 44 to 13eos/hpf, respectively). Sixty-four percent of participants met the criteria for a histologic response and 70% had peak counts ≤10eos/hpf after SFED; symptom scores improved for 94% of participants. Problem foods identified on reintroduction were wheat (60% of cases) and milk (50% of cases). Only 13% of foods associated with EoE were identified on skin-prick testing.
"An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults," the authors write. "Food reintroduction re-initiated features of EoE in patients, indicating a role for food allergens in its pathogenesis."