A comparison of three diets prescribed for eosinophilic esophagitis found that all three were effective in children. One, however, the elemental diet, was more likely to induce remission than either the six-food elimination diet or a diet based on skin-test reactions.
The results were published online in the Journal of Allergy and Clinical Immunology.
"There is no hard rule as all three diets studied worked. The specific choice would depend on the particular history of the patient and their preferences," Dr. Marc Rothenberg, Director of Cincinnati Center for Eosinophilic Disorders and pediatrician at the Cincinnati Children's Hospital, who led the study, told Reuters Health by email.
Eosinophilic esophagitis was first described less than 20 years ago, so it is relatively new to medicine and not well understood. The condition is increasingly common in both children and adults, researchers who spoke with Reuters Health say, and it has become a leading cause of dysphagia.
Dr. Rothenberg's comparison of dietary treatments is timely and important, says Dr. Chris Liacouras, a pediatric gastroenterologist at The Children's Hospital of Philadelphia who was not involved in the study.
"Although sometimes difficult to implement (because of quality of life restrictions), most physicians agree that whenever possible, food restriction or total elimination should be considered for patients with eosinophilic esophagitis," Dr. Liacouras told Reuters Health in an email.
The 98 patients in the series reported by Dr. Rothenberg and colleagues were all no older than 21.
Forty-nine patients received an elemental diet, i.e., a formula containing crystalline amino acids. In this group, 96% had disease remission - and patients had odds of remission that were 5.6 times higher than for patients on the six-food elimination diet and 12.5 times higher than for those on the test-directed diet.
Twenty-six patients went on the six-food elimination diet, in which they stopped eating milk, soy, wheat, eggs, nuts and fish/shellfish. A little more than half of these patients also stopped eating other foods to which they were allergic. Remission occurred in 81%.
Twenty-three patients went on test-directed diets, in which they stopped eating foods that provoked reactions on skin-prick or atopy-patch tests. The remission rate was 65% in this group.
Based on reintroduction, the foods most frequently associated with eosinophilic esophagitis were wheat (60% of cases) and milk (50% of cases). Skin-prick testing predicted only 13% of offending foods, leading the research team to say the study "does not substantiate a reliable role for skin testing in dietary therapy for eosinophilic esophagitis."
There was no significant difference in the remission rates between the six-food elimination group and the test-directed group.
The findings confirm previously published studies that demonstrate a link between the disease and food allergens, says Dr. Ikuo Hirano, a gastroenterologist at Northwestern University in Chicago who was not involved in the research.
"The concept that common foods such as milk or wheat can induce an allergic inflammation of the esophagus making it difficult for patients to ingest nutrients is both surprising and disturbing," Dr. Hirano told Reuters Health.
The superiority of the elemental diet is also supported by past research, Dr. Hirano says. But he warns that even though Dr. Rothenberg's hospital is "one of the leading centers for eosinophilic esophagitis research," the retrospective nature of the study is a limitation.
The authors agree, concluding, "Further prospective study is warranted to elucidate the limitations and strengths of each dietary therapy, to optimize the initial diet in such a way as to obviate the need for food reintroductions, and to determine which patients require an elemental diet at presentation."
J Allergy Clin Immunol 2012. Abstract
Rob Goodier • Reuters Health Information © 2012