Food allergy free diet may improve disease activity in eosinophilic gastritis, gastroenteritis
A food allergy free diet may effectively improve histologic, molecular, endoscopic and symptomatic disease activity in adult patients with eosinophilic gastritis/gastroenteritis, according to data from Digestive Disease Week.
“Element is the prospective dietary trial in patients with [eosinophilic gastritis/gastroenteritis] EG/EGE,” Nirmala Gonsalves, MD, professor of medicine in the division of gastroenterology at Northwestern University, the Feinberg School of Medicine, said during her virtual presentation. “... Suggesting a dominant role for food antigens in the EG/EGE pathogenesis.”
Gonsalves and colleagues identified 15 adult patients with EG/EGE. All patients received treatment with a food allergen-free diet of elemental formula for 6 weeks. The percentage of patients with complete histologic remission by biopsy taken during endoscopy at end of treatment served as the primary endpoint. Other exploratory outcomes included improvement in symptoms (Severity of Dyspepsia Assessment [SODA]), endoscopy (Eosinophilic Gastritis Reference Score [EGREFS]), blood eosinophilia, quality of life scores (Patient Reported Outcomes Information Measurement [PROMIS]), physician global assessment (PhGA), EG-relevant gastric transcriptome via EG-Diagnostic Panel (EGDP) and microbiome analysis.
Symptom duration was 8.8 years. Investigators observed multisegment involvement of the GI tract in 87% of patients. Presenting symptoms included abdominal pain (73%), dysphagia (73%), diarrhea (47%), nausea (33%) and vomiting (27%). Eighty-seven percent of patients had atopic disorders such as allergic rhinitis (60%), asthma (40%), eczema (13%) and food allergy (60%), and 33% had peripheral eosinophilia.
Findings from baseline endoscopy included granularity (80%), erosions/ulcers (60%), raised lesions (27%), erythema (93%), friability (20%), and thick folds (20%). All patients who completed the trial met the primary endpoint of histologic remission. Eosinophil decreased in the stomach and duodenum. The PhGA score decreased from 4.5 to 2 (P = .002). Data showed improvement in EGREFS scores (8.3; P = .003) and SODA improved in pain intensity (P = .044), non-pain scores (P = .039) and satisfaction scores (P= .0024). Additionally, there were improvements in PROMIS scores in depression (P = .0078) and fatigue (P = .04) domains and the EGDP score (P = .036).
“We did see significantly, an improvement in pain intensity, non-pain and satisfaction scores as well as improvement in depression and fatigue scores post treatment,” she said. – by Monica Jaramillo
Reference: Gonsalves N, et al. Abstract 229. Presented at: Digestive Disease Week; May 2-5, 2020; Chicago (meeting canceled).
Disclosures: Gonsalves reports she is an up-to-date chapter author, serves on the Allakos Advisory board and receives funding from a CEGIR (U54 AIll7804) grant. The study received formula donation from Nutritia.