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

Wechsler, J.B.; Schwartz, S.; Arva, N.C.; Kim, K.A.; Chen, L.; Makhija, M.; Amsden, K.; Keeley, K.; Mohammed, S.; Dellon, E.S.; Kagalwalla, A.F.

Clin Gastroenterol Hepatol.. 2021 Apr 3; S1542-3565(21):00384-0


Background: 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 histological efficacy of dietary elimination of all CM protein-containing foods in EoE.
Methods: We performed a prospective observational study in children with EoE treated with One Food Elimination Diet (1FED) excluding all CMP. Children and their caretakers were educated by a registered dietitian regarding dietary elimination of all CM protein-containing foods with substitutions to meet nutritional needs for optimal growth and development, and daily meal planning. Upper endoscopy with biopsies was performed after 8-12 weeks of treatment. The primary endpoint was histologic remission, defined as <15 eosinophils per high-power field (eos/hpf). Secondary endpoints were symptomatic, endoscopic, and quality-of-life (QOL) improvements.
Results: Forty-one children (76% male, 9±4 years, 88% white) underwent 1FED education and post-treatment endoscopy with biopsies. Histological remission occurred in 21 (51%) children, with a decrease in peak eos/hpf from (median [IQR]) 50 [35, 70] to 1 [0, 6] (p<0.0001). Endoscopic abnormalities improved in 24 (59%) of 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 1FED.
Conclusions: One food elimination of CMP containing foods from the diet induced histological 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 1FED as first line dietary treatment.
Keywords: EoE; antigen; children; dairy; dietary; response; treatment.

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