Summary of Cutting Just One Food Can Treat Eosinophilic Esophagitis:
A clinical trial funded by the National Institutes of Health has found that eliminating just animal milk from the diet of adults with eosinophilic esophagitis (EoE) is as effective in treating the condition as eliminating animal milk and five other common foods. EoE is a chronic disease characterized by an overabundance of white blood cells called eosinophils in the esophagus. The new findings come from the first multi-site, randomized trial comparing the six-food elimination diet (6FED) with a one-food elimination diet (1FED) in adults with EoE. The trial involved 129 adults with a confirmed EoE diagnosis.
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Eosinophils are a type of white blood cell that play a crucial role in fighting off infections caused by allergens and parasites. Their role in the immune response has led to them being closely studied for their link to various allergic and inflammatory conditions. Recent studies have found that diet-based therapy may be an effective way to treat eosinophilic esophagitis (EoE), a chronic condition characterized by an overabundance of eosinophils in the esophagus, through the elimination of certain trigger foods.
The past few years have seen a growing interest in the possibility of removing one to four of the most common food antigens from the diet as a way to treat EoE. These studies have shown some measure of success, but their effectiveness when compared to a six-food elimination diet (6FED) remained unclear. This prompted scientists to conduct the first multi-center randomized trial of its kind, comparing the outcomes of a one-food elimination diet (1FED) to the 6FED.
The trial, funded by the National Institutes of Health (NIH), involved 129 adults between the ages of 18 and 60 years with a confirmed EoE diagnosis, active symptoms, and a high number of eosinophils in esophageal tissue. Participants were randomly assigned to either the 1FED, which eliminated only animal milk from the diet, or the 6FED. They followed their assigned diet for six weeks, then underwent an upper endoscopy exam and an esophageal tissue biopsy. If the number of eosinophils in the tissue indicated that EoE was in remission, the participant exited the study.
The results, published in the journal The Lancet Gastroenterology & Hepatology, showed that eliminating just animal milk from the diet was just as effective as eliminating six common food triggers of esophageal injury. Interestingly, the two diets had a similar impact across several other measures, including a reduction in EoE symptoms and an effect on quality of life. This was an unexpected finding, as the 6FED had previously been the gold standard for EoE treatment.
The researchers also discovered that nearly half of the people who did not respond to the 1FED attained remission after treatment with the stricter 6FED, while more than 80% of the non-responders to 6FED achieved remission with oral steroids. This suggests that effective therapies are available for people who do not achieve remission after 1FED or 6FED.
Hugh Auchincloss, M.D. and acting director of NIAID, summed up the results by saying, “Diet-based therapy for eosinophilic esophagitis will be much easier to follow for many people if it involves cutting just one food from the diet rather than six.”
These findings have important implications for the management of EoE, as they suggest that a one-food elimination diet may be a reasonable first-line diet therapy option. For those whose disease persists even after avoiding animal milk, a stricter diet may assist them in achieving remission, while those who do not respond to either diet may benefit from oral steroids.
In conclusion, the results of this study provide valuable insights into the efficacy of different dietary approaches for the treatment of eosinophilic esophagitis. While more research is needed to fully understand the mechanisms underlying this disease, these findings offer hope for those living with the condition and may pave the way for more personalized treatment options in the future.
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