EoE Module 8 References-Molina-Infante et al J Allergy Clin Immunol 2018 Step up empiric elimination diet for pediatric and edult EoE The 2-4-6 study

Molina-Infante et al J Allergy Clin Immunol 2018 Step up empiric elimination diet for pediatric and edult EoE The 2-4-6 study

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The study titled "Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study" conducted by Javier Molina-Infante and colleagues explored a dietary approach for treating eosinophilic esophagitis (EoE) by eliminating common food triggers step-by-step. EoE is a chronic immune-mediated disease characterized by esophageal dysfunction, primarily triggered by food antigens, though distinct from typical IgE-mediated food allergies. The study utilized a multicenter, prospective design involving 130 patients across 14 centers in Spain and Italy. These patients, aged two years and above, had shown no histologic response to proton pump inhibitor therapy and were selected for the diet trial.<br /><br />The researchers initially implemented a two-food-group elimination diet (TFGED) focusing on removing milk and gluten for six weeks. If the patients did not achieve remission, they progressed to a four-food-group diet (FFGED) that included egg and legumes, and then potentially to a six-food-group diet (SFGED) adding nuts and seafood. Remission was defined by symptom improvement and a reduction in eosinophils.<br /><br />The TFGED was effective for 43% of all participants. Subsequent stages yielded remission rates of 60% with the FFGED and up to 79% with the SFGED, implying that more extensive dietary restrictions increased efficacy. The study found milk to be the dominant trigger, particularly in children. By stepping up dietary restrictions, the process became more resource-efficient, reducing endoscopic procedures and shortening diagnostic times compared to beginning with more comprehensive eliminations.<br /><br />Overall, the study concludes that a step-up approach allows effective management of EoE and early identification of food triggers, providing a practical framework for patients and healthcare providers aiming to use dietary therapy over pharmacological treatments. The findings also emphasize the limited necessity for extensive dietary exclusions when fewer food triggers are responsible for EoE.

Keywords

eosinophilic esophagitis

step-up diet

food elimination

pediatric EoE

adult EoE

dietary triggers

multicenter study

immune-mediated disease

milk trigger

dietary therapy