EOSINOPHILIC ESOPHAGITIS ATTRIBUTED TO GASTROESOPHAGEAL REFLUX - IMPROVEMENT WITH AN AMINO ACID-BASED FORMULA

Background & Aims: Treatment for gastroesophageal reflux may be ineffe ctive 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 m ay be associated with the ingestion of certain foods. Methods: Ten chi ldren previously diagnosed with gastroesophageal reflux by standard te sting with long-standing symptoms (median, 34.3 months; range, 6-78 mo nths) despite standard antireflux therapies, including Nissen fundopli cation in 6 patients, were fed the elemental formulas Neocate or Neoca te-1-Plus (Scientific Hospital Supplies Inc., Gaithersburg, MD) for a minimum of 6 weeks. Each child had repeat endoscopy followed by open f ood challenges. Results: While receiving the formulas, patients had ei ther resolution (n = 8) or improvement (n = 2) of symptoms. On follow- up esophageal biopsy, the maximal intraepithelial eosinophil counts de creased significantly before (median, 41; range, 15-100) to after (med ian, 0.5; range, 0-22) the formula trial (P = 0.005). Other reactive e pithelial changes of the esophageal mucosa also improved significantly . All patients redeveloped their previous symptoms on open food challe nges. Conclusions: Chronic gastrointestinal symptoms and histological changes of the esophagus unresponsive to standard treatments for gastr oesophageal reflux were improved by the use of elemental formulas. Sym ptoms recurred when specific dietary proteins were reintroduced during open food challenges. The mechanism of these observations is unknown.