Pediatric eosinophilic esophagitis: easier elimination as good as more restrictive diet

  • Wong J & al.
  • Pediatr Gastroenterol Hepatol Nutr
  • 1 Jan 2020

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • For children with eosinophilic esophagitis (EoE), a dairy-free diet (DFD) works as well as the more difficult 6-food elimination diet (SFED). 
  • Adding proton-pump inhibitor (PPI) therapy to DFD may improve response rates.
  • Prospective trial warranted.

Why this matters

  • Treatment has not been standardized.
  • Both a DFD and the SFED are efficacious and are frequently recommended.
  • Some elimination diets are more expensive and burdensome than others.

Key results

  • Response rate with DFD vs SFED: 56.9% vs 52.0%.
  • Post- vs pretreatment eosinophil counts per high-powered field (all P≤.0001):
    • Overall sample: 21.3±1.9 vs 45.9±2.0.
    • DFD group (n=102): 20.6±2.3 vs 42.2±2.3.
    • SFED group (n=50): 19.0±4.1 vs 52.4±4.2.
  • Post- vs pretreatment abnormal endoscopic findings:
    • Overall: 53.9% (82/152) vs 72.4% (110/152; P=.0009).
    • DFD group: 52.9% (54/102) vs 69.6% (71/102; P=.0363).
    • SFED group: 56.0% (28/50) vs 78.0% (39/50; P=.0005).
  • Response rates did not differ by age or atopy status.
  • On bivariate but not multivariate analysis, success rates among DFD patients were higher with vs without concomitant PPI treatment.

Study design

  • Single-center retrospective study of children treated for EoE with either DFD or SFED (n=152).
  • Outcomes: histological response. 
  • Funding: None disclosed.

Limitations

  • No compliance measures.
  • PPI dosing was not noted.