Summary of One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial
Introduction
In the realm of medical science, the constant exploration and study of various diseases and their treatments remains a priority. One such disease is Eosinophilic Esophagitis, a chronic immune system disease. This article presents a summary of a multicentre, randomised, open-label trial that compared the effectiveness of a one-food elimination diet (1FED) against a six-food elimination diet (6FED) in treating this condition.
Background
Empirical elimination diets have proven effective in achieving histological remission in patients with eosinophilic oesophagitis. However, until now, there have been no randomised trials comparing different diet therapies. This trial aimed to address this gap by comparing a six-food elimination diet (6FED) with a one-food elimination diet (1FED).
Methods
The trial was conducted across ten sites of the Consortium of Eosinophilic Gastrointestinal Disease Researchers in the USA. The participants were adults aged between 18 and 60 years with active, symptomatic eosinophilic oesophagitis. They were randomly allocated to either the 1FED (animal milk) or 6FED (animal milk, wheat, egg, soy, fish and shellfish, and peanut and tree nuts) for 6 weeks. The primary endpoint was the proportion of patients with histological remission.
Key Findings
At the end of 6 weeks, 40% of patients in the 6FED group had achieved histological remission compared with 34% in the 1FED group. While there was no significant difference between the groups at stricter thresholds for partial remission, the proportion of patients with complete remission was significantly higher in the 6FED group.
Interpretation
The trial concluded that the histological remission rates and improvements in histological and endoscopic features were similar after 1FED and 6FED in adults with eosinophilic oesophagitis. However, 6FED showed efficacy in just less than half of 1FED non-responders, and steroids were effective in most 6FED non-responders. This suggests that eliminating animal milk alone can be a viable initial dietary therapy for eosinophilic oesophagitis.
Conclusion
The findings of this multicentre, randomised, open-label trial offer a new perspective on the treatment of eosinophilic oesophagitis. More importantly, it gives hope to patients suffering from this chronic condition that a simple alteration in diet could potentially alleviate their symptoms and improve their quality of life.
Please note: This article is a summary of the original study and should not be taken as medical advice. Always consult with a healthcare professional for medical guidance.
References:
- Kliewer KL, Gonsalves N, Dellon ES, Katzka DA, Abonia JP, Aceves SS, Arva NC, Besse JA, Bonis PA, Caldwell JM, Capocelli KE, Chehade M, Cianferoni A, Collins MH, Falk GW, Gupta SK, Hirano I, Krischer JP, Leung J, Martin LJ, Menard-Katcher P, Mukkada VA, Peterson KA, Shoda T, Rudman Spergel AK, Spergel JM, Yang GY, Zhang X, Furuta GT, Rothenberg ME. One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial. Lancet Gastroenterol Hepatol. 2023 May;8(5):408-421. doi: 10.1016/S2468-1253(23)00012-2. Epub 2023 Feb 28. PMID: 36863390; PMCID: PMC10102869.
