Eosinophilic inflammation of the esophagus relieved by diet

By Sally Robertson, B.Sc.Feb 18 2013

A diet that eliminates six food types has proved effective at inducing remission of eosinophilic esophagitis (EoE) in adults, report researchers.

The 6-food elimination diet, which excludes cow's milk, cereals, eggs, fish/seafood, legumes/peanuts, and soy, induced histopathologic remission of EoE (<15 eosinophils/high power field [hpf]) in almost three-quarters of patients with adult EoE who followed the diet for 6 weeks.

Furthermore, all patients who continued to avoid the offending foods after the study maintained EoE remission for up to 3 years, making the diet "a feasible, drug-free maintenance therapy," say Alfredo Lucendo (Hospital General de Tomelloso, Spain) and colleagues.

As reported in the Journal of Allergy and Clinical Immunology, 49 (73.1%) of 67 patients had a significant response to the diet, with a decrease in their mean esophageal eosinophil count from 47.9 eosinophils/hpf at baseline to 3.5 eosinophils/hpf after the study. Thirty-seven patients achieved a complete histologic reponse (0-5 eosinophils/hpf) and 12 achieved a partial response (6-10 eosinophil/hpf).

All of the responders were subsequently challenged with reintroduction of the excluded foods.

The team reports that a single offending food antigen was detected in 15 (36%) patients, two were identified in 13 (31%) patients, and three or more were identified in 14 (33%) individuals. None of the patients completed the challenge without recurrence of histopathologic EoE.

The most commonly identified food antigen was cow's milk (in 62.0%), followed by wheat (28.6%), eggs (26.2%), and finally legumes (23.8%).

Follow-up data available for 15 patients who successfully avoided the foods for a further 2 years and for four patients who avoided the foods for 3 years, showed that all of the individuals remained asymptomatic of EoE, with esophageal eosinophil counts of fewer than five eosinophils/hpf in their annual endoscopic examinations.

"These results are comparable with previously reported findings in children and also validate recently reported results in adults, all of them from retrospective observations," write Lucendo and team.

"We can thus confirm that food antigens are the major triggers in inducing and maintaining eosinophil esophageal inflammation for patients of all ages, providing additional evidence that pediatric and adult types of EoE constitute a single disease."

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