Last week, this blog posted an abstract regarding the use of “real foods” for short gut kids. This post looks into whether certain foods may provoke an allergic response.
A large (n=105) single center retrospective study (C Duggan et al. JPGN 2016; 63: 336-39) examined the histology from 208 endoscopic procedures to determine the frequency of eosinophilic disease in children with intestinal failure.
- 37% of patients had evidence of eosinophilic inflammation in at least one section of the GI tract.
- Most common sites for eosinophilic disease: colon/rectosigmoid 18/68 (26%), esophagus 17/83 (20%), ileum 9/54 (17%) and duodenum 4/83 (5%)
- Both peripheral eosinophilia and hematochezia correlated with eosinophilic colitis
- The authors state that “a strict elemental diet for 3 months before endoscopy was not associated with a decreased frequency of eosinophilic inflammation.”
While a strict elemental diet was not shown to be effective in this study, the limitations of the study design (eg. retrospective, small number on amino acid diet) preclude a definitive answer about the utility of these diets. Other confounders, including ongoing parenteral nutrition support, also ‘muddy’ the picture. A prospective study would be able to determine more conclusively how effective elemental diets are at minimizing eosinophilic inflammation and to allow for a more uniform definition of abnormal tissue eosinophilia.
Given the frequency of elemental diets early in life along with prior GI insults, the propensity to eosinophilic disease may have its origins well before this study period. In healthy children, the LEAP, LEAP-ON, and EAT studies indicated that earlier exposure to allergens reduces the risk of allergic disease.
My take: This study shows a high prevalence of GI eosinophilic inflammation among children with intestinal failure. Thus, in children with hematochezia and intestinal failure, eosinophilic colitis needs to be considered.
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