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Gastrointestinal Disease
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Justine Turner, Sally Schwartz
Pharmacological therapy, such as inhaled steroids in swallowed form, is effective in reducing esophageal inflammation. Diet therapies are also commonly used to treat EoE in children. Dietary antigens are strongly implicated in causing the allergic response in EoE. Nutrition therapy for treatment of EoE involving diet elimination addresses the root cause of inflammation, treats EoE by removing the underlying food trigger(s) of inflammation, and is preferred by families not wanting pharmacological therapy. Multiple elimination diets are used to treat EoE: Elemental diet is a liquid diet provided by an elemental formula prescribed to meet 100% of nutrition needs; the efficacy of this diet in achieving histological remission is ~90%.Allergy-directed elimination diet involves removing foods based on allergy testing. Efficacy of this diet therapy is < 50% reflecting the poor specificity of such testing to predict EoE food allergens.Empiric elimination diets involve removing the most common food allergens (cow’s milk, soy, egg, wheat, peanut/tree nut, fish/shellfish). Efficacy has been reported to be 72% when removing all six foods (wherein nuts include tree nuts and peanuts; fish includes fin fish and shellfish, giving rise to eight separate food groups).
Irritable Bowel Syndrome
Published in Nicole M. Farmer, Andres Victor Ardisson Korat, Cooking for Health and Disease Prevention, 2022
The elemental diet is not really a “food” diet at all but rather powdered predigested nutrients which one mixes with water, and drinks, in many cases exclusively, for 2 weeks or more. The idea behind it is that all of the nutrients are absorbed high up in the small intestine not leaving any left over for subsequent fermentation lower down in the intestine. Elemental diets have been used for a while now with Crohn’s disease (Ohara et al. 2017), but more recently, people are looking at using it for IBS/SIBO. One study by a very prominent SIBO researcher, Dr. Mark Pimentel, MD, conducted on IBS patients with an abnormal breath test reading for SIBO, found that 85% of patients had an improvement in their breath test results following a 2-week elemental diet (Pimentel et al. 2004).
Allergic Diseases
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Adam Fox, George Du Toit, Stephan Strobel
If this fails to control symptoms, a standard ‘few foods’ diet (oligoallergenic diet), containing few known food allergens, can be used. In extreme circumstances, an elemental diet (containing basic nutritional necessities without conventional food) may occasionally be needed.
Current treatment options and long-term outcomes in patients with eosinophilic esophagitis
Published in Expert Review of Clinical Immunology, 2022
Alfredo J Lucendo, Javier Molina-Infante
An elemental diet consists of exclusive feeding with a single amino acid-based formula, devoid of antigenic capacity. By far, it is the most effective dietary approach, with histological remission in over 90% of children and adults, according to a recent first meta-analysis [23]. However, this dietary strategy has a number of setbacks. These include poor palatability, psychosocial disadjustment and impairment of quality of life due to complete avoidance of any table food, as well as the cost implications of supporting such a strategy (often without reimbursement). Potential therapeutic roles for this extremely restrictive diet may include refractory patients who wish to be kept in remission while addressing the casual role of unusual allergens, or as a bridge therapy while waiting for investigational drugs.
Elimination diets for eosinophilic esophagitis: making the best choice
Published in Expert Review of Clinical Immunology, 2020
The history of treating EoE with a diet began with the elemental diet (ELED), first implemented by Kelly et al in 1995, with resultant improvement of patients’ symptoms and esophageal histology, hence establishing food proteins as a cause of the inflammation in EoE [15]. The ELED consists of exclusive feeding of an amino acid-based formula, and sometimes allowing 1–2 foods of low allergenic potential to be concurrently consumed, the latter referred to as a modified elemental diet [30]. In the study by Kelly et al, of 10 children that received this elimination diet for a minimum of six weeks, 8 had resolution and 2 had improvement of symptoms. On follow-up esophageal biopsies, peak esophageal eosinophil counts significantly decreased, from a median of 41 to 0.5 eosinophils/high power field (HPF). These positive results were replicated in several larger studies in children with EoE [16,33] and in studies in adults with EoE [17,34]. The ELED is highly effective because all but 1–2 food proteins are eliminated from the diet, and the formula that is used as the main source of nutrition is non-allergenic, i.e. does not contain any of the intact proteins or peptides that can elicit an immunological response in patients. In a systematic review by Arias et al [9], the histological remission rate of ELED therapy was calculated to be around 90% in children and 94% in adults with EoE. In addition to the high histological remission rate, the ELED was generally found to be highly effective in reducing symptoms in almost all children [15,16,35] and in adults with less advanced disease [17,34]. It also significantly improved esophageal findings on endoscopy except when fixed esophageal strictures were present [17,34].
Predictors of necessity for endoscopic balloon dilatation in patients with Crohn’s disease-related small bowel stenosis
Published in Annals of Medicine, 2021
Yukie Hayashi, Kaoru Takabayashi, Naoki Hosoe, Hiroki Kiyohara, Satoshi Kinoshita, Kosaku Nanki, Kayoko Fukuhara, Yohei Mikami, Tomohisa Sujino, Makoto Mutaguchi, Takaaki Kawaguchi, Motohiko Kato, Haruhiko Ogata, Takanori Kanai
The characteristics of the 40 patients who underwent EBD and those who did not are shown in Supplementary table 1. There was a significant difference in disease location and location of strictures. Patients who received EBD were significantly more likely to use the Elemental diet.