Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis

Kagalwalla, Amir F.; Wechsler, Joshua B.; Amsden, Katie; Schwartz, Sally; Makhija, Melanie; Olivé, Anthony; Davis, Carla M.; Manuel-Rubio, Maria; Marcus, Seth B; Shaykin, Ronda; Sulkowski, Maureen; Johnson, Krista; Ross, Jessica; Riffle, Mary Ellen; Groetch, Marion; Melín-Aldana, Héctor; Schady, Deborah; Palac, Hannah; Kim, Kwan Youn A.; Wershil, Barry K.; Collins, Margaret H.; Chehade, Mirna

doi:10.1016/j.cgh.2017.05.048

Cited by 153 publications

(115 citation statements)

References 17 publications

(26 reference statements)

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“…Empiric elimination of single foods (milk) and 2 foods (milk and wheat) are also being actively investigated as alternatives to the SFED. 63,64 Empiric elimination diets still allow continued consumption of a restricted number of table foods, including fruits, vegetables, meat, poultry, rice, beans, and nonwheat grains. The typical duration for empiric elimination diets is 6 to 8 weeks, followed by a repeat endoscopy.…”

Section: Empiric Elimination Dietmentioning

confidence: 99%

“…Although there is no standardized approach to food reintroduction and follow-up endoscopy after an empiric elimination diet, typically, a repeat endoscopy is performed after introduction of 1 to 2 foods. 64 The current requirement for repeated endoscopies during reintroduction is a considerable drawback to this approach, particularly in pediatric patients exposed to general anesthesia. 65 Practically, the elimination diet can be onerous because of concerns with dietary contamination, the psychosocial effect of restricted diets, and the costs of allergen-free food products.…”

Section: Empiric Elimination Dietmentioning

confidence: 99%

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Diagnosis and treatment of eosinophilic esophagitis

Gonsalves

Aceves

2020

Journal of Allergy and Clinical Immunology

105

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Section: Empiric Elimination Dietmentioning

confidence: 99%

Section: Empiric Elimination Dietmentioning

confidence: 99%

Diagnosis and treatment of eosinophilic esophagitis

Gonsalves

Aceves

2020

Journal of Allergy and Clinical Immunology

105

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“…However, in the Spanish study, the following foods were excluded: mammalian milk, wheat/gluten‐containing grains, eggs and soy/legumes including peanuts. Two prospective non‐randomized trials of four food exclusion diets have been conducted, one in adults in Spain (n = 52) and another multi‐centre trial in children (n = 78) from the USA . In adults, 54% (28/52) achieved remission defined as a 50% decrease in symptom score and histologic <15 eos/hpf after a 6‐week intervention.…”

Section: Dietmentioning

confidence: 99%

Food avoidance strategies in eosinophilic oesophagitis

Cianferoni

Shuker²,

Brown‐Whitehorn

et al. 2019

Clin Experimental Allergy

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Summary Eosinophilic oesophagitis (EoE) is a chronic disease associated with significant morbidity that can result in permanent fibrosis and stricture formation. Given the complexity, a multidisciplinary approach is recommended to manage these patients. In the majority of children with EoE not responsive to proton‐pump inhibitor (PPI), inflammation is driven by sensitivity to foods and treatment with an elimination diet can be effective. Foods most commonly identified to trigger EoE in children are milk and wheat, but egg, soy, meats and grains can also be triggers. Foods can be eliminated using a step‐down or step‐up approach. If the goal is to achieve quick remission, elemental diet or six food elimination diets are the most effective. A step‐up approach starting from a 1‐2 food elimination diet and increasing the number of foods based on a personalized dietary approach is recommended if the goal is to achieve remission using the least number of endoscopies and with increased acceptability to the patient. Children with EoE on elimination diets require frequent monitoring of growth and nutrition, as well as screening for symptoms of EoE, allergy and mindfulness regarding psychosocial impact of chronic disease on the family and child. Current research focused on tools to select patients who mostly will benefit from dietary treatment, identify relevant food allergens, obtain oesophageal tissue non‐invasively and induce tolerance will greatly improve the treatment of EoE.

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“…It has been reported to be highly effective in treating EoE, achieving histological remission in 75% of patients with EoE [8]. Recently, the four-food elimination diet, avoiding cow’s milk, wheat, eggs, and legumes, was reported to achieve histological remission in 71% of children with EoE [9], while an even more recent study showed that a step-up diet strategy in treating childhood EoE is feasible: the two-food elimination diet restricting animal milk and gluten-containing cereals achieved remission in 40% of the patients with EoE, while the four-food elimination diet achieved remission in 52% and the six-food elimination diet in 65%. Amongst responders to a two-food elimination diet, the most common food triggers were animal milk and gluten-containing cereals (15%), while animal milk alone or gluten-containing cereals alone were reported in 60 and 25% of patients, respectively [10].…”

Section: Eosinophilic Esophagitismentioning

confidence: 99%

Eosinophilic Gastrointestinal Diseases in Childhood

Koutri

Papadopoulou

2018

Ann Nutr Metab

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Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.

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Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis

Cited by 153 publications

References 17 publications

Diagnosis and treatment of eosinophilic esophagitis

Diagnosis and treatment of eosinophilic esophagitis

Food avoidance strategies in eosinophilic oesophagitis

Eosinophilic Gastrointestinal Diseases in Childhood

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