Elemental diet therapy for eosinophilic gastroenteritis and dietary habits

Abstract

Background Eosinophilic gastrointestinal disorders (EGID) are a group of conditions with increased eosinophilic infiltration in any part of the gastrointestinal tract. Although an allergic reaction to certain foods is considered the main cause of EGID, their detailed pathomechanism has not yet been elucidated, nor have proper management strategies been fully established. Moreover, some patients with intractable EGID are resistant to such therapies as an empirical elimination diet and corticosteroids. Methods We analyzed retrospectively the medical records of four children with intractable eosinophilic gastroenteritis (EGE) managed with elemental diet therapy (EDT) using an amino acid‐based formula. Results All patients displayed resolution of their symptoms after 2 weeks of EDT. Three patients successfully completed food reintroduction and could return to their normal life. No adverse events related to EDT were recorded. Conclusions Elemental diet therapy appears effective and safe for treating pediatric intractable EGE symptoms. Afterwards, the patient’s dietary habits should be considered during carefully monitored food reintroduction. With the relatively small number of published case reports and no randomized trials, more study is needed on EDT for EGE.

Eosinophilic enteritis requiring differentiation from chronic enteropathy associated with SLCO2A1 gene: A case report

“…EGE is usually difficult to diagnose because of the variety of gastrointestinal symptoms, as well as the extremely nonspecific findings of gastrointestinal endoscopy[ 11 ]. A case series that reported the small intestinal capsule endoscopic findings in 10 EGE cases found small intestinal lesions such as multiple erythematous lesions in 6 cases, erosions and ulcers in 5 cases, flattened or missing villi in 4 cases, and intestinal stenosis in 7 cases[ 9 ]. In that study, EGE was defined as EGID with extensive lesions extending from the stomach to the large intestine; however, only one pediatric and 6 adult cases of EoN localized to the small intestine have been reported (Table 2 )[ 12 - 17 ].…”

“…The patient was treated with montelukast (10 mg/d for a total of 26 mo), which reduced the frequency of abdominal pain. Partial elemental diet therapy (600 kcal/day for a total of 24 mo) was also implemented due to insufficient response of hypoalbuminemia and anemia[ 9 ]. Corticosteroids were not administered because the patient's family preferred that steroids be avoided.…”

The Association between Dietary Habits and Rapid Postoperative Recovery of Rotator Cuff Repair

“…However, EOs in the blood may also be elevated due to the intake of dietary proteins [46,47]. For example, there are eosinophilic gastrointestinal disorders that are usually caused by food protein, and elemental diet therapy using an amino acid-based formula can improve eosinophilic gastroenteritis, potentially reducing the number of EOs [48]. Therefore, these nutrients from meat, fruits, and wheat flour may affect recovery via EOs.…”

Preliminary evidence in treatment of eosinophilic gastroenteritis in children: A case series

“…The treatment of eosinophil gastroenteritis is still empirical. Current treatments for eosinophilic gastroenteritis include restricted diet/elemental diet therapy, corticosteroids, and steroid-sparing agents[ 2 , 15 , 18 , 19 ]. Although dietary therapy was reported to be effective in relieving allergic eosinophilic gastroenteritis[ 20 , 21 ], low patient compliance limits its usefulness, especially in adolescents and adults.…”

“…However, there is still no validated guideline for the clinical management of patients with eosinophilic gastroenteritis, let alone standard guideline for children. Some evidence in the case report/series suggests that dietary restrictions (or elemental diet therapy) and the use of corticosteroids and steroid-sparing agents such as prednisone and montelukast are effective as first-line treatments[ 2 , 15 ]. Considering the rarity of this disease in China and the limited understanding of its diagnosis and treatment, the aim of this study was to report our experience with the diagnosis and treatment outcome of 22 children with eosinophilic gastroenteritis in China.…”