Study of the Week: Eliminate Cow’s Milk Products to Treat Pediatric Eosinophilic Esophagitis

Welcome to Study of the Week from Patient Worthy. In this segment, we select a study we posted about from the previous week that we think is of particular interest or importance and go more in-depth. In this story we will talk about the details of the study and explain why it’s important, who will be impacted, and more.

If you read our short form research stories and find yourself wanting to learn more, you’ve come to the right place.


This week’s study is…

A single food milk elimination diet is effective for the treatment of eosinophilic esophagitis in children

We previously published about this research in a story titled “Is A Milk-Free Diet Good for Children With Eosinophilic Esophagitis?” which can be found here. The study was originally published in the research journal Clinical Gastroenterology and Hepatology. You can view the abstract of the study here.

What Happened?

Prior studies have revealed that cow’s milk protein (CMP) is the most frequent trigger of an inflammatory reaction in people of all ages living with eosinophilic esophagitis (EoE), a rare allergic inflammatory condition. With this knowledge in mind, the research team sought to determine if eliminating foods containing CMP from the diet of children living with the disease could improve the symptoms and avoid symptom triggers.

In this observational study, the affected children and their caregivers were advised on the elimination of CMP and directed towards substitutions of any CMP-containing foods so that optimal growth and development would not be affected. In addition, daily meal planning was implemented for the participants. A total of 41 patients participated. Any food derived primarily from cow’s milk, such as most cheeses, may contain CMP, as well as many others that may not appear to at first glance, such as certain candies, cereal, flavored potato chips, and even hot dogs.

These patients then underwent upper endoscopy, including biopsies, after anywhere from 8-12 weeks of eliminating the consumption of CMP. The primary endpoint in this evaluation was histologic remission, which was defined as less than 15 eosinophils/high-power field (eos/hpf). Secondary endpoints included improvements in quality of life, symptoms, and other endoscopic measures. 51 percent of the participants achieved the primary endpoint, with eos/hpf dropping from a median of 50 to 1 eos/hpf.

Meanwhile, 59 percent saw improvements in endoscopic abnormalities and 61 percent saw improvements in their symptoms. Examples of symptoms that saw improvement included dysphagia, spitting up food, and chest pain. While parents thought their quality of life worsened, the patients themselves reported better quality of life.

About Bacterial Meningitis

Eosinophilic esophagitis (EoE), is a condition in which the esophagus becomes inflamed due to an allergic reaction that involves the activity of eosinophils, a form of white blood cell. Generally, the allergic reaction is triggered by some type of food that the patient has eaten, but it is often difficult to determine which specific food item is the cause. Symptoms of eosinophilic esophagitis include difficulty swallowing, nausea, painful swallowing, heartburn, rings in the esophagus, narrowing of the esophagus, blockage of the esophagus, and vomiting. Current treatments involve medication to suppress the immune response, eliminating known food allergens, and expanding the esophagus. Many people with the condition also have other autoimmune problems, such as celiac disease or asthma. To learn more about eosinophilic esophagitis, click here.

Why Does it Matter?

The findings from this study reinforce the importance of diet in managing eosinophilic esophagitis. It also highlights how vital it can be for patients to ask their physicians for specific testing in order to identify the specific allergen that is triggering symptoms of the condition. Unfortunately, it can be challenging to do this and it may require close monitoring of diet from the patient’s caregivers.

It’s also important to be working with a knowledgeable physician with significant experience and familiarity with the disease, as many doctors may not be aware of the fact that CMP is the most widespread triggering allergen in eosinophilic esophagitis. Nevertheless, if the allergen can be successfully pinpointed, then the relative ease of adhering to and implementing this management approach should make it a great option for many patients.

“One food elimination of CMP containing foods from the diet induced histological remission in more than 50% of children with EoE and led to significant improvement in symptoms and endoscopic abnormalities. The ease of implementation and adherence supports 1FED as first line dietary treatment.”

Check back the Monday of each week for the next installment in this series.

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