Swallowing problems are common among children as well as adults. Eosinophilic esophagitis is being increasing recognized as a prominent cause.
Overview of eosinophilic esophagitis
- Allergy mechanism is involved.
- Food allergies have been implicated.
- Optimal treatment has thus far been less than satisfactory.
- Elemental diet as well as six food elimination diet (SFED) has shown promise in children with a symptomatic response rate of 97% .
Symptoms of Eosinophilic esophagitsis
What is Six-Food Elimination Diet or SFED?
SFED diet involves exclusion of following from diet:
- Cow’s milk
- Tree nuts
- Fish especially shell fish
Six-food elimination diet plan is not a classic food allergy dietary approach in which food targets are based on food sensitization patterns .
Design of SFED elimination diet study
- Prospective clinical study at Northwestern University School of Medicine.
Initial testing of subjects
- Patients underwent skin prick testing to identify any specific known allergies.
- Potential allergens in air that were tested included tree, grass, ragweed, house-dust and mold etc.
- Testing for food allergans included peanuts, tree nuts, eggs, wheat, milk, soy.
Methods of SFED elimination diet study
- Patients underwent a baseline upper GI endoscopy, then 6-weeks of six food elimination diet and then again an upper GI endoscopy with biopsies.
- Those patients whose biopsies showed normalization then were introduced to specific foods one at a time ( for 2-weeks each)
- Repeat endoscopy and biopsy of esophagus in order to identify the food trigger in that particular subject.
Patients studied in SFED elimination diet study
- 50 subjects participated in the initial component
- 20 subjects completed the reintroduction diet plan
Effect on dysphagia or swallowing problem
- 94% of subjects dervied benefit
- Dysphagia frequency scores declined from a median 3.5 to 2.0
- Dysphagia duration score decreased from 2.2 to 1
- Dysphagia intensity score decreased from 3.4 to 1.8.
- Endsocopic scores improved in 78% percent of patients.
- SFED also resulted in improved quality of life as measured by SF-36 scores.
Are all foods equally to blame?
- Wheat was involved in 60%
- Milk contributed to the disease in 50% of the cases.
- Symptom recurrence occurred in all 20 subjects upon reintroduction of elimination diet components along with abnormalities on upper GI endoscopy and biopsy.
Elimination diet trial versus skin prick testing
- Skin prick testing was able to identify specific allergen in only 13% of the cases.
Limitations of SFED elimination diet study
- Uncontrolled study
- The “normalization” of the biopsy specimens did notocur in 36% of patients despite symptomatic improvement
Conclusions of of SFED elimination diet study
- The normalization of biopsies on histology is less than that is seen in response to elemental diet in children.
- Other dietary allergans, cross-allegans and/or involvement of aeroallergens may be involved.
- SFED provides a reliable and practical means of identifying food triggers and tailor the dietary regimen accordingly.
- Diet may not be able to cure.
- Finding of the eggs and wheat being the commonest offending agent is consistent with data from other studies.
A thought to ponder and link
- Gluten free, casein free diet has been shown to be of benefit in autism.
- Wheat is source of gluten while cow's milk is source of casein!
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