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A Single Food Milk Elimination Diet Is Effective for Treatment of Eosinophilic Esophagitis in Children

Published:April 03, 2021DOI:https://doi.org/10.1016/j.cgh.2021.03.049

      Background & Aims

      Cow’s milk protein (CMP) is the most common trigger of inflammation in children and adults with eosinophilic esophagitis (EoE). We sought to assess the clinical, endoscopic, and histologic efficacy of dietary elimination of all CMP-containing foods in EoE.

      Methods

      We performed a prospective observational study in children with EoE treated with the 1-food elimination diet (1FED), excluding all CMP. Children and their caretakers were educated by a registered dietitian regarding dietary elimination of all CMP-containing foods, with substitutions to meet nutritional needs for optimal growth and development, and daily meal planning. Upper endoscopy with biopsies was performed after 8 to 12 weeks of treatment. The primary end point was histologic remission, defined as fewer than 15 eosinophils per high-power field. Secondary end points were symptomatic, endoscopic, and quality-of-life (QOL) improvements.

      Results

      Forty-one children (76% male; ages, 9 ± 4 y; 88% white) underwent 1FED education and post-treatment endoscopy with biopsies. Histologic remission occurred in 21 (51%) children, with a decrease in peak eosinophils per high-power field from a median of 50 (interquartile range, 35–70) to a median of 1 (interquartile range, 0–6; P < .0001). Endoscopic abnormalities improved in 24 (59%) patients, while symptoms improved in 25 (61%). Improved symptoms included chest pain, dysphagia, and pocketing/spitting out food. Parents perceived worse QOL, while children perceived improved QOL with the 1FED.

      Conclusions

      One-food elimination of CMP-containing foods from the diet induced histologic remission in more than 50% of children with EoE and led to significant improvement in symptoms and endoscopic abnormalities. The ease of implementation and adherence supports the 1FED as first-line dietary treatment.

      Keywords

      Abbreviations used in this paper:

      1FED (1-food elimination diet), 4FED (4-food elimination diet), CMP (cow’s milk protein), EoE (eosinophilic esophagitis), eos/hpf (eosinophil per high-power field), HSS (histologic scoring system), IQR (interquartile range), PEC (peak eosinophil count), PPI (proton pump inhibitor), QOL (quality of life), SFED (6-food elimination diet)
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