Amino Acid-Based Diet Induces Histological Remission, Reduces Clinical Symptoms and Restores Esophageal Mucosal Integrity in Adult Eosinophilic Esophagitis Patients
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Marijn J Warners, Berber J Vlieg-Boerstra, PhD RD, Joanne Verheij, Marleen T.J Van Ampting, Lucien F Harthoorn, Wouter J de Jonge, Andreas J.P.M Smout, Albert J Bredenoord
Rationale: The pathophysiology of eosinophilic esophagitis (EoE) is mainly driven by food allergy, whereby an increase in mucosal permeability might facilitate transepithelial allergen flux in the esophagus. Studies on the effect of elemental diets in adults are scarce and unpalatability makes adherence challenging. The aim of this study was to assess the effect of a ready-to-drink amino acid-based formula (Neocate, Nutricia) on eosinophilic inflammation and to study its effect on the integrity of esophageal mucosa. Additionally, adherence to this formula was evaluated.

Methods: In this prospective study 21 adult patients with active EoE were included. Patients underwent endoscopy before and 4 weeks after dietary treatment. Clinical, endoscopic and histological responses, along with the mucosal integrity of the esophagus were evaluated, using electrical tissue impedance in vivo and transepithelial electrical resistance and molecule flux through esophageal biopsies in Ussing chambers. 

Results: Peak eosinophil count decreased significantly after the diet from 40 to 9 per high power field (p<0.001). In total, 17 (81%) of the included patients completed the diet, 12 (71%) patients showed complete histological response (≤15 eosinophils) and another 4 (24%) patients showed partial histological response (≥50% decrease). Symptoms decreased substantially and 15 patients (88%) became completely asymptomatic (p<0.001). A strong improvement of endoscopic signs was observed (p<0.000). Esophageal permeability decreased and mucosal resistance increased significantly (p<0.05).

Conclusions: This study strongly indicates that in adults with EoE, a ready-to-drink amino acid-based diet reduces eosinophilic inflammation, induces clinical remission and restores the esophageal mucosal integrity. Patient’s adherence to this diet is better than previously described.