Dietary treatment of eosinophilic gastrointestinal disorders in children

Abstract

Purpose of review To provide an overview of recent developments on dietary treatment of eosinophilic gastrointestinal disorders (EGID) in children. Recent findings Food antigens are the main triggers of eosinophilic esophagitis (EoE); however, currently available allergy tests cannot reliably identify eliciting antigens. Studies evaluating the six-food empiric elimination diet (6FED-milk, wheat/gluten, egg, soy/legumes, nuts and fish/seafood) have shown histological remission rates of 72%. Milk, egg, wheat/gluten, and, to a lesser extent, soy/legumes were the most frequent food triggers with only one or two culprit foods identified for most patients. A 4-food elimination strategy afforded a 64% remission rate. A step-up two-four-six food elimination diet generated a 43% remission rate at the two-food elimination stage, and similar reported rates for 4FED and 6FED. Endoscopic procedures were reduced by a 20% compared with 6FED. In a prospective study including 63 children, exclusive milk elimination has been effective in 44% of them. Controlled elimination and reintroduction with histological assessment is necessary. Summary Dietary therapy of EoE has evolved from more restrictive to less restrictive diets to provide better balance between efficacy vs. nutritional deficiencies and quality of life. Data on efficacy of dietary therapy in other EGIDs are very scarce.

Is Endoscopic Assessment of the Esophagus and Stomach Enough to Determine the Need for Biopsy at These Sites in Pediatric Patients Undergoing Endoscopy for Elevated TTG?

“…Sixteen (7%) of the 215 patients who had biopsies underwent clinical interventions based on the findings, Table 2, Supplemental Table 1. Of the patients with normal endoscopic appearance, 6 (3%) of these 188 patients had clinical interventions (histamine H2-receptor antagonist (H2 blocker) started-2 patients; elimination diet for eosinophilic disease 17 and proton pump inhibitor (PPI) started-1 patient; referral to allergy-1 patient; PPI weaned and calcium carbonate started-1 patient; and switched from one PPI to a different PPI-1 patient). Twelve (6%) of the 215 patients had esophagitis with abundant eosinophils which could be compatible with eosinophilic esophagitis in the appropriate clinical setting.…”

Evidence-based treatments for eosinophilic esophagitis: insights for the clinician

“…52 Even when successful in inducing remission, the dietary reintroduction process after elemental diet therapy is lengthy, and requires multiple endoscopies with biopsies and several months of continued nutritional support while normal diet is gradually returned. 53 All this significantly reduces the real possibility of using exclusive elemental diets in clinical practice as a bridge therapy for highly refractory infants and toddlers while waiting for investigational drugs, as well as for patients who wish to remain in remission while investigating the casual role of unusual foods and aeroallergens in their disease. Flavored formulas are recommended as too is the combining of elemental formula with solid foods which have the least probability of being involved as food triggers.…”

Textbook of Pediatric Gastroenterology, Hepatology and Nutrition

“…Systemic corticosteroids are reserved for severe symptoms requiring rapid relief or where other treatments have failed [66]. Significant differences in general practice between pediatric and adult gastroenterologist were demonstrated with notable divergence from consensus guidelines [70]. Although elimination diets remain an appropriate option, the vast majority of adults suffering from EoE will be started on topical corticosteroids for long-term management, mainly as a result of the poor long-term compliance to elimination diets [71].…”