Observational studyClinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association2017
Efficacy of a 4-Food Elimination Diet for Children With Eosinophilic Esophagitis.
Observational study in Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03657771 (A Food Additive Removal Diet for Pediatric Eosinophilic Esophagitis), which is not on this map. Cited by 79 papers, 5 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Food Additive Removal Diet for Pediatric Eosinophilic Esophagitis
Who cites it
79 citing papers in PubMed, 5 syntheses or guidelines pooled it, 179 citations in OpenAlex.
- Is Milk Elimination Enough? A Systematic Review and Meta-Analysis of One-Food Elimination Diet in Eosinophilic Esophagitis.Medical sciences (Basel, Switzerland) · 2026Pooled it
- Efficacy of Dietary Therapy for Eosinophilic Esophagitis in Children and Adults: An Updated Systematic Review and Meta-Analysis.Nutrients · 2024Pooled it
- Pooled it
- Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters.Gastroenterology · 2020Guideline
- Eosinophils and eosinophil-associated diseases: An update.The Journal of allergy and clinical immunology · 2018Pooled it
- One-food versus six-food elimination diet therapy for the treatment of eosinophilic oesophagitis: a multicentre, randomised, open-label trial.The lancet. Gastroenterology & hepatology · 2023Trial
- Effect of amino acid-based formula added to four-food elimination in adult eosinophilic esophagitis patients: A randomized clinical trial.Neurogastroenterology and motility · 2022Trial
- A Novel Allergen-Specific Immune Signature-Directed Approach to Dietary Elimination in Eosinophilic Esophagitis.Clinical and translational gastroenterology · 2019Trial
- Efficacy of Atopy Patch Testing in Directed Dietary Therapy of Eosinophilic Esophagitis: A Pilot Study.Digestive diseases and sciences · 2018Trial
- Dietary Approaches in Eosinophilic Esophagitis.Nutrients · 2026Review
- Advances in Management of Eosinophilic Esophagitis in Pediatrics.Paediatric drugs · 2026Review
- Clinical Patterns and Outcomes of Eosinophilic Esophagitis in Children and Adolescents at a Tertiary Care Center in Lebanon.Children (Basel, Switzerland) · 2026Article
- Eosinophilic esophagitis in children: Clinical perspectives and evolving therapeutic strategies.World journal of gastrointestinal endoscopy · 2026Review
- Evaluation of Functional T-Cell Assays That Predict Causal Allergens in Eosinophilic Esophagitis.Diagnostics (Basel, Switzerland) · 2026Article
- Pediatric eosinophilic esophagitis among children attending a tertiary hospital in Nairobi, Kenya: a case series.Frontiers in allergy · 2026Article
- Panallergen sensitization in children with eosinophilic esophagitis: a pilot study.Frontiers in allergy · 2026Article
- The Potential Link Between Eosinophilic Esophagitis and Food Allergy: Inflammatory Pathogenesis and Management.Journal of inflammation research · 2026Review
- The Therapeutic Pipeline for Eosinophilic Esophagitis: Current Landscape and Future Directions.Pharmaceuticals (Basel, Switzerland) · 2025Review
- [Eosinophilic esophagitis-an underestimated food allergy?]Dermatologie (Heidelberg, Germany) · 2025Review
- Eosinophilic Esophagitis: Prevalence, Diagnosis, and Treatment in Childhood and Adulthood.Deutsches Arzteblatt international · 2025Review
19 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
22 authors at 7 institutions in 1 country.
Funding
Abstract
BACKGROUND &
aimsA 6-food elimination diet induces remission in most children and adults with eosinophilic esophagitis (EoE). The effectiveness of empiric elimination of only 4 foods has not been studied in children. We performed a prospective observational outcome study in children with EoE treated with dietary exclusion of cow's milk, wheat, egg, and soy. The objective was to assess the clinical, endoscopic, and histologic efficacy of this treatment in EoE.
methodsWe recruited children (1-18 years old, diagnosed per consensus guidelines) from 4 medical centers. Study participants (n = 78) were given a proton pump inhibitor twice daily and underwent a baseline esophagogastroduodenoscopy. Subjects were instructed on dietary exclusion of cow's milk, wheat, egg, and soy. Clinical, endoscopic, and histologic assessments were made after 8 weeks. Responders had single foods reintroduced for 8 weeks, with repeat endoscopy to assess for recurrence of active disease. The primary endpoint was histologic remission (fewer than 15 eosinophils per high-powered field). Secondary endpoints included symptom and endoscopic improvements and identification of foods associated with active histologic disease.
resultsAfter 8 weeks on 4-food elimination diet, 50 subjects were in histologic remission (64%). The subjects' mean baseline clinical symptoms score was 4.5, which decreased to 2.3 after 8 weeks of 4-food elimination diet (P < .001). The mean endoscopic baseline score was 2.1, which decreased to 1.3 (P < .001). After food reintroduction, the most common food triggers that induced histologic inflammation were cow's milk (85%), egg (35%), wheat (33%), and soy (19%). One food trigger that induced recurrence of esophageal inflammation was identified in 62% of patients and cow's milk-induced EoE was present in 88% of these patients.
conclusionsIn a prospective study of children with EoE, 8 weeks of 4-food elimination diet induced clinical, endoscopic, and histologic remission in more than 60% of children with EoE. Although less restrictive than 6-food elimination diet, 4-food elimination diet was nearly as effective, and can be recommended as a treatment for children with EoE.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.