The following is a summary of “Prospective study of an amino acid–based elemental diet in an eosinophilic gastritis and gastroenteritis nutrition trial,” published in the SEPTEMBER 2023 issue of Allergy & Immunology by Gonsalves, et al.
Eosinophilic gastritis and gastroenteritis (EoG/EoGE) are uncommon conditions characterized by excessive eosinophils in the stomach and/or small intestine. Although these disorders lack an established treatment, they are thought to have an allergic origin, which remains inadequately explored in terms of both mechanisms and therapies. For a study, researchers sought to assess the efficacy of a food allergen-free diet, specifically an elemental formula, in managing gastrointestinal eosinophilia in adult patients with EoG/EoGE.
Adults between 18 and 65 years old, diagnosed with active EoG/EoGE through histological evidence (with 30 or more eosinophils per high-power field in the stomach and/or duodenum) and recent gastrointestinal symptoms, were prospectively enrolled in a single-arm clinical trial. They received the elemental formula continuously for six weeks. The primary objective was to determine the percentage of participants who achieved complete histologic remission, defined as having fewer than 30 eosinophils per high-power field in both the stomach and duodenum. Secondary outcomes included improvements in symptoms, endoscopy findings, blood eosinophil count, quality of life, Physician Global Assessment score, and the gastric transcriptome and microbiome relevant to EoG.
In the study, fifteen adult participants, consisting of 47% males, with an average age of 37.7 years and an average symptom duration of 8.8 years, completed the trial. Notably, 87% of these individuals exhibited involvement of multiple gastrointestinal segments. Encouragingly, all subjects achieved complete histologic remission in the stomach (P = .002) and the duodenum (P = .001), indicating a robust response to the intervention. Additionally, the study identified significant improvements in various parameters. Overall, Physician Global Assessment (PhGA) scores exhibited notable enhancement (P = .002), as did EGREFS (P = .003) and EGDP (P = .002). Specifically, improvements in SODA pain intensity (P = .044), non-pain symptoms (P = .039), and satisfaction (P = .0024) were observed. Furthermore, PROMIS depression (P = .0078) and fatigue (P = .04) scores showed significant reductions, suggesting improved psychological well-being. Interestingly, these previously observed improvements were reversed when participants reintroduced regular food into their diets. This reversal underscores the influence of food allergens on the development and progression of EoG/EoGE. It is noteworthy that the intervention was well tolerated, with only one serious adverse event reported in a single subject. This highlights the safety profile of the amino acid-based elemental diet employed in the study.
In conclusion, the study highlighted the effectiveness of an amino acid-based elemental diet in improving various parameters related to EoG/EoGE. The findings strongly suggested that food allergens play a pivotal role in the pathogenesis of these disorders.