Single-food milk elimination diet works in paediatric eosinophilic esophagitis

In the treatment of children with eosinophilic esophagitis (EoE), eliminating foods that contain cow’s milk protein (CMP) from the diet is effective, inducing relatively high rates of histologic remission and significantly improving symptoms and endoscopic abnormalities, as shown in a study.

The study included 41 children (mean age 9 years, 76 percent male, 88 percent White). All of them underwent a one-food elimination diet (1-FED) intervention that excluded all CMP-containing foods. A registered dietitian educated the children and their caretakers regarding this dietary intervention, with substitutions to meet nutritional needs for optimal growth and development, and daily meal planning.

Researchers performed upper endoscopy with biopsies after 8 to 12 weeks of intervention. They assessed histologic remission, defined as fewer than 15 eosinophils per high-power field, as the primary endpoint. Secondary endpoints included symptomatic, endoscopic, and quality-of-life (QOL) improvements.

A total of 21 children (51 percent) achieved histologic remission on 1-FED, with peak eosinophils per high-power field markedly decreasing from a median of 50 (interquartile range, 35–70) to a median of 1 (interquartile range, 0–6; p<0.0001).

Furthermore, 24 children (59 percent) had improvements in endoscopic abnormalities, while 25 (61 percent) patients experienced symptom relief. Among the symptoms that improved were chest pain, dysphagia, and pocketing/spitting out food.

Parents noted worse quality of life (QOL), while children perceived improved QOL with the 1-FED.

The findings suggest the potential of 1-FED, which has the added advantage of easy implementation and high adherence, as first-line dietary treatment in paediatric EoE.