One of the topics that continues to have a number of important articles each month is eosinophilic esophagitis. One of the most important recent articles is the following:
**Kagalwalla AF, et al. JPGN 2011;53: 145–149. Identification of Specific Foods Responsible for Inflammation in Children With Eosinophilic Esophagitis Successfully Treated With Empiric Elimination Diet.
Results: A total of 36/46 (25 M/11F) children who were initially successfully treated with SFED completed this trial; the mean age was 7.6 years. The most common foods identified were 25 to cow’s milk (74%), 8 to wheat (26%), 4 to eggs (17%), 3 to soy (10%), and 1 to peanut (6%). Milk was 8 times more likely to cause EoE compared with wheat, the next most common food (95% confidence interval 2.41–26.62, P1⁄4 0.0007).
Previous articles in this area include the following:
–Immunol Allergy Clin N Am; 2009; 29: 77-84. Review article.
–Clinical Gastroenterology & Hepatology 2006; 4: 1097.
–Clinical Gastroenterology & Hepatology 2006; 3: 1198.
These studies identify the divergent approaches to dietary treatment in patients with eosinophilic esophagitis. Some patients can be managed with elimination diet based on allergy testing. However, due to the difficulty of allergy testing and its potential flaws in this population, some patients need to resort to a so-called six-food group elimination diet (Milk, wheat, eggs, nuts, shellfish, and soy) and some even need a complete elemental diet. Almost all patients managed with dietary restriction require followup endoscopy to determine the effectiveness of this dietary approach. In subsequent posts, some of the references regarding medical treatments (eg. budesonide) and biomarkers will be reviewed.