Eosinophilic oesophagitis dietary therapy: milk elimination as effective as excluding six foods

By Melanie Hinze

Eliminating animal milk alone is an acceptable initial dietary therapy for eosinophilic oesophagitis, new research published in Lancet Gastroenterology and Hepatology has found.

The researchers conducted a head-to-head comparison of a six-food elimination diet (6FED) comprising animal milk, wheat, egg, soy, fish and shellfish, and peanut and tree nut elimination versus eliminating animal milk only – including cow, goat and sheep milk (1FED).

Animal milk was chosen for the 1FED protocol as previous diet studies have indicated that milk was one of the most common food triggers in adults with eosinophilic oesophagitis, and that it was the most frequent single causative food antigen in most children with the condition.

The multicentre, randomised, open-label trial was conducted across 10 sites in the USA. It incorporated 129 adults aged 18 to 60 years (mean age 37 years; 46% female) with active, symptomatic eosinophilic oesophagitis. These patients were randomly assigned in a 1:1 ratio to the 1FED or the 6FED protocol.

At six weeks, 40% of patients in the 6FED group had achieved histological remission, compared with 34% in the 1FED group, a difference that was not statistically significant. Changes in quality-of-life scores were small and similar between the groups, as were adverse events.

The proportion of patients with complete remission was significantly higher in the 6FED group. It was also found that for patients without histological response to 1FED who went on to the 6FED regimen, 43% then achieved histological remission.

The researchers concluded that for patients with eosinophilic oesophagitis who wanted to pursue empirical diet therapy, it was acceptable to start with the easier 1FED strategy rather than the more restrictive 6FED strategy as an initial approach.

Associate Professor Christopher Pokorny, Gastroenterologist at Sydney Hospital and Adjunct Associate Professor of Medicine at UNSW Sydney, said it was known that histological remission could be achieved in some patients with eosinophilic oesophagitis through a diet eliminating wheat, milk, nuts, seafood, eggs and soy.

‘This is an important study demonstrating that in one-third of patients, histological remission can be achieved through avoiding animal milk alone,’ he told Medicine Today.

‘Given the difficulty in compliance with a six-food elimination diet, eliminating animal milk and milk products provides an initial alternative to patients who wish to explore all avenues prior to medical therapy,’  he added.

Lancet Gastroenterol Hepatol 2023; https://doi.org/10.1016/S2468-1253(23)00012-2.