A combination of dietary advice and provision of commercially available food items enabled subjects with a low-moderate habitual consumption of WG to substantially increase their WG intake, but there was little effect on blood biochemical markers, body composition, BP, fecal measurements, or gut microbiology. This trial was registered at www.controlled-trials.com as ISRCTN36521837.

Despite the dramatic increase in WG consumption, there were no effects on phenotypic or functional immune parameters, markers of inflammation or metabolic markers.

Introduction Eosinophilic oesophagitis (EoE) is an immune‐mediated, chronic disease characterized by eosinophilic inflammation and esophageal dysfunction. Specific food allergens including cow's milk protein, are partially causative to disease progression, and dietary management forms three main options; the elemental diet (ED), the empirical elimination diet (EED), and the targeted elimination diet (TED). The dietary choice should be individualized, however, the European Society for Pediatric Gastroenterology, Hepatology and Nutrition guidelines recommend an ED for pediatric EoE with multiple food allergies, failure to thrive, unresponsive disease or unable to follow a highly restricted diet. The aim of this narrative review was to explore the effectiveness of the ED (using amino acid formula [AAF]), in the management of pediatric EoE. Methods Literature searches were performed to identify eligible studies that described outcomes including eosinophil count, clinical symptoms, growth, and medications. Results Overall, 10 eligible studies were found, with n = 462 patients assigned to receive AAF from a total of n = 748 (average age 6.7 years), for a duration of 4 to 8 weeks. The use of AAF reduced eosinophil levels and demonstrated remission (defined as ≤10 eosinophils per high power field) in 75%‐100% of children with improvements, if not resolution, in clinical symptoms. AAF was more clinically effective than the use of the EED or TED, where remission rates were 75%‐81% and 40%‐69%, respectively. Few studies collected growth outcomes, however where documented these were positive for those on AAF. The long‐term impacts of each diet were not thoroughly explored. Conclusions The use of AAF is a clinically effective management option for pediatric EoE, and further research is required to guide long‐term management.

BackgroundHealthy gut microbiota is important for prognosis in cow's milk allergy (CMA). The application of synbiotics (specific pre‐ and probiotics) in extensively hydrolyzed formulae (eHFs) is a relatively new concept.AimsTo evaluate a synbiotic‐containing, whey‐based eHF (SeHF) with galacto‐oligosaccharides, fructo‐oligosaccharides, and bifidobacterium breve M‐16V in infants with CMA.Materials and MethodsA 31‐day one‐arm pilot study in 29 infants with CMA (mean age 30.8 weeks [SD 11]) was undertaken, with outcomes including gastrointestinal tolerance, atopic dermatitis symptoms, dietary intake, growth, SeHF acceptability, caregiver quality of life, and hospital‐related healthcare use.ResultsSignificant improvements (p < .05) in the severity of abdominal pain (in 57%), burping (in 46%), flatulence (in 79%), constipation (in 14%), rhinitis (41%), and itchy eyes (73%), as well as atopic dermatitis in those with severe baseline symptoms (PO‐SCORAD© reduction: 34.7–18.2 (p = .003), n = 6) were observed over time. Growth and caregiver quality of life scores significantly increased (+26.7%, p < .05) over time. Hospital visits and medications significantly reduced (−1.61 and −2.23, respectively, p < .005) in the 6 months after SeHF initiation.DiscussionIn this small, single‐arm, pilot study, the use of SeHF enhanced the management of infants with non‐IgE mediated CMA who were already established on eHF. Conclusion: Whilst this study adds to the evidence base for the use of SeHF in CMA, further robust research to explore the longer‐term benefits of synbiotics, specifically the blend used in this study, for the clinical management of infants with CMA is warranted.

results and the correlation between endoscopy and clinical outcome defined as discharge from hospital follow up. Patients and Methods Retrospective review of clinical databases from June 2015 to July 2019. Only first diagnostic endoscopies were included, subsequent endoscopies and therapeutics endoscopies were excluded. Number of clinics prior and up to 6 months of endoscopies were reviewed and outcomes at 6 months were assessed. Correlation between endoscopy, histology results and outcome at 6 months were calculated using phi correlation Results 196 children were included, 47.6% were females. Mean (± SD) age 10.9 (± 3.8). Indications were: abdominal pain 33%, diarrhoea 14%, rectal bleeding 9%, suspected coeliac 7.5%, constipation 9%, reflux 12.3% and vomiting 15.1%. 71.3% were upper endoscopies only and 28.7% were upper and lower endoscopies. 64% of all endoscopies were normal and 43.4% of the total were histologically normal. Number of clinics prior to endoscopies were 1.39 (±1.0) and children were seen 2.3 (±1.6) times in the six months after endoscopy. 18.5% of children were discharge from follow up within 6 months of having an endoscopy. There was weak (phi 0.18) but statistically significant (p<0.05) correlation between endoscopy and discharge at 6 months. There was also weak (phi 0.2, p 0.006) correlation between histology results and discharge at 6 months. There was a strong (phi 0.46 p<0.005) positive correlation between endoscopic appearance and histological results.All children were day cases and there was no complication identified in the studied population. Conclusion Paediatric endoscopy appears to be a safe procedure with low risk of complication and most children were discharge on the same day. The majority of endoscopies in children were normal and about half were histologically normal with strong positive correlation between endoscopic and histological results, hence biopsies should not be performed if endoscopy is normal. Endoscopy did not appear to influence discharge from hospital follow up and the majority of children were still under follow up 6 months after having an endoscopy.

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