The use of amino acid‐based nutritional feeds is effective in the dietary management of pediatric eosinophilic oesophagitis

Abstract

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.

A Clinical Perspective on the Dietary Therapies for Pediatric Eosinophilic Esophagitis: The Gap Between Research and Daily Practice

“…In conclusion, the ELED is highly effective in the management of pediatric EoE, but should rather be used in formula fed infants or as a final rescue therapy for older children who did not experience histological remission on other dietary therapies ( 7 , 31 , 32 ).…”

Cow’s Milk Allergy or Gastroesophageal Reflux Disease—Can We Solve the Dilemma in Infants?

“…The exact prevalence of EoE in both breast-and formula-fed infants [61] is difficult to determine because few infants have endoscopy and esophageal biopsies before been attempted CM free diet or PPI treatment. Moreover, pediatric EoE case series did not provide a subgroup analysis of infants [89] and one large report on infant esophagitis did not detail eosinophilic infiltration [56]. Noteworthy, several early-life factors, including maternal fever, preterm labor, cesarean delivery, esophageal atresia, antibiotic or acid suppressant use in the first months of life, dysbiosis, other atopic conditions and celiac disease have been associated with risk of pediatric EoE [90,91].…”

“…On the contrary, in infants the first and, in almost all cases, the only treatment needed for EoE is CM free diet with recommended amino acid formula [31,86,87]. In a recent review of ten studies, enrolling 462 EoE patients (mean age 6.7 years, range, 4 months-20 years), elemental diet resulted in clinical and histological remission (defined as ≤10 eosinophils/hpf) in 75-100% of children [89]. Despite diagnostic difficulties an early recognition of EoE is important to resolve or reduce clinical manifestations and possible long term esophageal complications.…”

Pathogenesis, diagnosis, dietary management, and prevention of gastrointestinal disorders in the paediatric population

“…A review showed that the use of AAF diminished eosinophil count, inducing remission in 75%-100% of children. Based on these data, AAF is considered superior compared with the food elimination diet (FED) [103][104][105]. However, an elemental diet with AAF is used only to treat persistent active EoE, refractory to other conventional drugs and/or empiric diets because of poor palatability, use of nasogastric tubes, lack of adherence, psychological impact, and high costs [103][104][105].…”