In this month’s Gastroenterology, 50 adults with Eosinophilic esophagitis (EoE) were treated with a 6-food elimination diet (SFED) (Gastroenterology 2012; 142: 1451-1459). Repeat endoscopy after 6 weeks determined responsiveness. Histologic response was defined by having <5 eosinophils/high power fields (eos/hpf). In 20 patients, reintroduction of foods followed by repeat endoscopy was undertaken.
After SFED, 32 (64%) had peak eosinophil counts <5 eos/hpf. Symptom scores decreased in 94%. After trigger food reintroduction, eosinophil counts returned to pretreatment values. The changes are clearly visible in Figure 5. The pictures are almost like the weight loss commercials on TV –striking improvement. I contemplated putting in a scan of the Gastroenterology cover, but have not received permission from the publisher. Check out this link to view it yourself:
Based on reintroduction, the foods most commonly associated with EoE were wheat (60%), and milk (50%). Skin-prick testing predicted only 13% of foods associated with EoE. In general, these study results mirror results from pediatric studies, with the exception that milk allergy has been found to be more common in some pediatric studies.
Only 20 patients completed the reintroduction process. This process involved adding 1 food group every 2 weeks. If the patient had symptoms during reintroduction or remained on regimen for 4 weeks, then endoscopy with biopsies was performed. If recurrence noted based on symptoms or histology, this required a 6 week washout before additional food reintroduction. Of note, median time for recurrence of symptoms was 3 days after reintroduction.
Six foods: milk, wheat, eggs, soy, shellfish/fish, nuts.
This study shows that, as in children, adult EoE is predominantly a food-allergy disease
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