PURPOSE OF THE STUDY.
To identify specific foods responsible for eosinophilic esophagitis (EoE) in children who achieved histologic remission with a 6-food elimination diet (SFED).
A cohort of 46 children aged 7.6 ± 4.3 years who achieved clinical and histologic remission with an SFED were studied in a children’s university hospital setting.
All children initially achieved clinical and histologic remission of EoE by using an SFED. Individual foods were then reintroduced with subsequent endoscopies and biopsies 6 weeks after each food reintroduction. Retrospective statistical analysis was used to determine odds ratios for each food.
Thirty-six (78%) children in the initial cohort of 46 completed the study. A single offending food was identified in 26 (72%) children. Cow’s milk (74%), wheat (26%), and egg (17%) were the 3 most common culprits.
In children who demonstrate histologic and clinical improvement after an SFED, cow’s milk is identified as the single most common food causing eosinophilic inflammation.
Once again, the current notion that EoE in children is not only difficult to diagnose and treat clinically but also lacks a consensus treatment algorithm has placed investigators in search for solutions. In this study, just eliminating cow’s milk resulted in EoE resolution in 56% (20/36) of children, while eliminating 6 food groups (cow’s milk, soy, wheat, egg, peanut/tree nut, and shellfish) has previously been shown to improve 85% of children. In scenarios where multifood elimination diets are difficult or multiple biopsies to assess histologic response are impractical, providers caring for children with EoE may find a stepwise SFED starting with cow’s milk more palatable.
- Copyright © 2012 by the American Academy of Pediatrics