EoE Module 8 References-Kelly et al Gastroenterology 1995 EoE attributed to gastroesophageal reflux Improvement with an amino acid based formula

Kelly et al Gastroenterology 1995 EoE attributed to gastroesophageal reflux Improvement with an amino acid based formula

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The study in "Gastroenterology" (1995) investigated the effects of an amino acid-based formula on children with eosinophilic esophagitis attributed to gastroesophageal reflux. Despite standard treatments for reflux, including Nissen fundoplication surgeries, ten children continued to experience symptoms and esophageal biopsy abnormalities. The researchers explored whether food-induced reactions might be responsible for these persistent issues.<br /><br />The study involved replacing the children's regular diets with the elemental formulas Neocate or Neocate-l-Plus, devoid of common dietary proteins, for a minimum of six weeks. Following the dietary intervention, all participants experienced either a resolution or a significant improvement in symptoms. Specifically, the study recorded a significant reduction in esophageal eosinophil counts from a median of 41 per 400x field before the trial to 0.5 thereafter.<br /><br />Upon reintroducing proteins, nine out of ten children experienced a return of symptoms when ingesting certain foods, such as cow's milk, soy, wheat, peanut, and egg, suggesting specific dietary proteins provoke symptoms in these children. Eighty percent of the patients avoided their previous medications, and solid food reintroduction was guided by identifying specific food allergies.<br /><br />The study highlighted the potential misdiagnosis of gastroesophageal reflux disease (GERD) when dietary hypersensitivity could be the root cause. It concluded that for pediatric patients who do not respond to traditional GERD treatments, the possibility of food-related hypersensitivity should be considered, using an amino acid-based formula as a viable elimination tool. The results underscored the need for further research to confirm these findings under double-blinded, placebo-controlled trials and to demystify the underlying mechanisms, whether allergenic or otherwise.

Keywords

eosinophilic esophagitis

gastroesophageal reflux

amino acid-based formula

Neocate

dietary proteins

food-induced reactions

esophageal eosinophil counts

dietary hypersensitivity

pediatric GERD

elimination diet