Gastroenterology

Gastroenterology

Volume 109, Issue 5, November 1995, Pages 1503-1512
Gastroenterology

Eosinophilic esophagitis attributed to gastroesophageal reflux: Improvement with an amino acid-based formula,☆☆

https://doi.org/10.1016/0016-5085(95)90637-1Get rights and content

Abstract

Background & Aims Treatment for gastroesophageal reflux may be ineffective in patients with an eosinophilic infiltration of the esophagus. The aim of this study was to investigate whether unremitting symptoms of gastroesophageal reflux and biopsy abnormalities of the esophagus may be associated with the ingestion of certain foods. Methods Ten children previously diagnosed with gastroesophageal reflux by standard testing with long-standing symptoms (median, 34.3 months; range, 6–78 months) despite standard antireflux therapies, including Nissen fundoplication in 6 patients, were fed the elemental formulas Neocate or Neocate-1-Plus (Scientific Hospital Supplies Inc., Gaithersburg, MD) for a minimum of 6 weeks. Each child had repeat endoscopy followed by open food challenges. Results While receiving the formulas, patients had either resolution (n = 8) or improvement (n = 2) of symptoms. On follow-up esophageal biopsy, the maximal intraepithelial eosinophil counts decreased significantly before (median, 41; range, 15–100) to after (median, 0.5; range, 0–22) the formula trial (P = 0.005). Other reactive epithelial changes of the esophageal mucosa also improved significantly. All patients redeveloped their previous symptoms on open food challenges. Conclusions Chronic gastrointestinal symptoms and histological changes of the esophagus unresponsive to standard treatments for gastroesophageal reflux were improved by the use of elemental formulas. Symptoms recurred when specific dietary proteins were reintroduced during open food challenges. The mechanism of these observations is unknown.

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Supported in part by grant RR-00052 from the General Clinical Research Center, Division of Research Resources, and National Institutes of Health and by a grant from Scientific Hospital Supplies Inc, (Gaithersburg, Maryland). Dr. Sampson is supported by grant AI-24439 from the National Institute of Allergy and Infectious Diseases and the National Institutes of Health.

☆☆

Presented in part at the annual meeting of the American Gastroenterological Association on May 16, 1994, in New Orleans, Louisiana.

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