Is A Milk-Free Diet Good for Children With Eosinophilic Esophagitis?

A study published in Physician’s Weekly posed the question: is removing milk from the diets of children with eosinophilic esophagitis a preferable treatment option? A team of researchers, led by Joshua B. Wechsler from the Northwestern University Feinberg School of Medicine, discovered that the answer is yes. They found that this diet is extremely helpful and should be used as the first line of dietary treatment.

About Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a digestive system disorder in which there are high levels of eosinophils in the esophagus. High amounts of these white blood cells typically accumulate when one is exposed to an allergen. Medical professionals have also found that some affected individuals have a high expression of the eotaxin-3 gene, so there may be a genetic component to this condition as well. Regardless of the cause, symptoms include difficulty swallowing, malnutrition, a poor appetite, nausea, vomiting, stomach pain, poor growth, weight loss, and food getting stuck in the throat. In terms of treatment, a change in diet has been proven to greatly improve symptoms. Doctors advise that patients avoid milk, fish, eggs, nuts, soy, and wheat. If one has a very severe case, they may need a liquid diet or steroids to reduce inflammation.

About the Study

The researchers began their study armed with the information that “milk is the most common trigger of inflammation” in EoE patients. Knowing this, they wanted to see if eliminating any food with cow’s milk protein (CMP) could be a viable, dietary treatment option.

Through an observational study, 41 children diagnosed with EoE were put on a One Food Elimination Diet (1FED), in which they restricted themselves from eating anything with CMP. To avoid any nutritional issues, both children and their caregivers were educated by a dietitian beforehand and were given a daily meal plan.

The children remained on this diet for a span of eight to twelve weeks, with biopsies and upper endoscopies performed at the end of the study. Researchers used these tests to evaluate the primary endpoint of the study, which was histologic remission. Additionally, they focused on the secondary endpoints of improvements to symptoms, quality of life, and endoscopy. Results included:

  • 21 patients experienced histologic remission
  • 24 patients saw improvements in endoscopic abnormalities
  • 25 patients reported improved symptoms
    • They reported less chest pain, spitting out food, and dysphagia

One interesting result of the study correlates to the caregivers. They believed that the children would report a worse quality of life after the completion of the study, but the children themselves perceived an improved quality of life.

Looking Forward

The fact that half of patients experienced histologic remission, more than half saw improved symptoms and endoscopic abnormalities, and the diet is easy to follow make researchers suggest it as a first-line dietary treatment. Removing milk and all products with CMP can improve the quality of life of those with eosinophilic esophagitis.

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