PURPOSE OF THE STUDY.
The purpose of this study was to evaluate the impact of various elimination diets on the nutritional status of children with eosinophilic esophagitis (EoE).
The study included 59 children consecutively referred to the pediatric gastroenterology department at the hospital Necker-Enfants Malades in Paris, France, who had nutritional assessment before and after a 2-month dietary therapy period without oral or topical corticosteroids. There were 37 boys and 22 girls ranging in age from 9 months to 15 years.
Children with EoE were treated with a modified 6 food elimination diet (SFED) consisting of elimination of cow’s milk protein, wheat, soy, egg, peanut and tree nuts, fish and shellfish, in addition to foods that were positive on skin prick test or allergy patch test and had elicited a previous clinical reaction. An amino acid formula was prescribed with a recommended daily consumption of 500 mL or more, accounting for >30% of daily caloric intake. Height for age (HFA) and weight for height (WFH) z scores were calculated by using reference curves of the French Child’s Medical Record Book.
Dietary therapy resulted in improvement in the esophageal endoscopic appearance in 47.4% of subjects, esophageal eosinophil counts of <15/high-power field (HPF) in 70% and improvement in clinical symptoms in 98%. Complete remission (defined as <5 eosinophils/HPF with no or improvement of symptoms) was seen in 35 of 59 children (59.3%), partial remission (defined as 6–14 eosinophil/HPF and partial symptom improvement) in 6 of 59 (10%), and nonremission in 18 of 59 children (30%). Postdiet height and weight gains were significant over the follow-up period, but the WFH z score did not change significantly. A 1-year follow-up was available for 33 patients with no significant improvement in WFH z score either.
Treatment with the modified SFED for a period of 2 months did not worsen the nutritional status of children with EoE.
EoE has become the most prevalent cause of esophageal symptoms among children and young adults. Treatment is either pharmacologic (topical glucocorticoids) or dietary. The latter includes an amino acid–based formula with 90.8% remission rates when used exclusively, an SFED with a 72.1% remission rate, and an elimination diet based on skin prick test– or allergy patch test–positive foods that is growing out of favor with 45.5% remission rates (Gastroenterology. 2014;146(7):1639–1648). Symptoms of EoE include failure to thrive, and parents are usually weary of further restricting the diet of their children. This study should reassure the practicing pediatrician and the families of children with EoE that dietary therapy is effective without resulting in further compromise in the nutritional status of the children affected.
- Copyright © 2015 by the American Academy of Pediatrics