Elemental diet may help adults with eosinophilic esophagitis

By Helen Albert, Senior medwireNews Reporter

Results from a small study suggest that consumption of an elemental diet for 2-4 weeks results in a significant histologic improvement in adult patients with eosinophilic esophagitis.

Patients, however, found it difficult to comply with the diet, the researchers note, and they did not experience any corresponding improvements in their symptoms - although the team suggests that longer follow up may be needed for clinical benefits to be realized.

Children with eosinophilic esophagitis can respond well to an elemental diet, consisting of a liquid meal replacement containing amino acids, fats, sugars, vitamins, and minerals.

To see if the approach may also benefit adults with the condition, Frederic Clayton (University of Utah Health Sciences Center, Salt Lake City, USA) and colleagues recruited 18 adult patients with eosinophilic esophagitis (≥15 eosinophils/maximal high power field [hpf]), aged 34 years on average, and assessed their outcomes after consumption of an elemental diet for 2 or 4 weeks.

The main aim of the study was to induce a complete histologic response (≤5 eosinophils/maximal hpf). Participants consumed the diet for 2 weeks if this response was achieved during this time (n=1) and for 4 weeks (n=17) if the response was only partial at 2 weeks.

As reported in the American Journal of Gastroenterology, 72% (n=13) of individuals had a partial or complete histologic response to the diet with mean eosinophils/maximal hpf decreasing from 54 at baseline to 10 at completion of treatment. All the participants who completed the study had some histologic improvement except for one treatment nonresponder.

Endoscopic findings also showed improvement after consumption of the elemental diet with significant reductions in the number of furrows and exudates observed from baseline.

Unpalatability was a problem with the diet, as out of 29 individuals who originally qualified for study inclusion, 11 dropped out or ate normal food in addition to the elemental diet during the study, thus violating the protocol.

Furthermore, there were no improvements in symptoms such as pill dysphagia, chest pain, or heart burn according to the Mayo Dysphagia Questionnaire-30.

The team concludes that "an elemental diet is effective in adult eosinophilic esophagitis and might be clinically useful in selected adult patients who fail to improve on other therapy, but it has the disadvantages of high cost, poor palatability, and a high dropout and noncompliance rate."

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