An elemental diet appears to restore esophageal mucosal integrity in eosinophilic esophagitis (EoE), according to data published in the American Journal of Gastroenterology.

Marijn Warners, MD, from the Department of Gastroenterology and Hepatology at the Academic Medical Center in Amsterdam, The Netherlands, and colleagues sought to assess duodenal permeability in EoE and evaluate the effect of an elemental diet on the esophageal and duodenal integrity in 17 adult EoE patients and 8 healthy controls.

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The researchers examined esophageal biopsy specimens before and after 4 weeks of an elemental diet to measure the eosinophil counts and gene expression of tight junction and barrier integrity proteins. They measured esophageal and duodenal impedance with electrical tissue impedance spectroscopy and used Ussing chambers to measure transepithelial resistance and transepithelial molecule flux. A dual sugar test measuring the lactulose/mannitol (L/M) ratio was used to analyze the small intestinal permeability.

After 4 weeks of elemental diet, the peak eosinophil count in the esophageal mucosa had decreased from 43 per high-power field to 9 per high-power field. The results showed that 71% of patients achieved complete histological response and 24% achieved partial response. The proportion of patients with moderate to severe spongiosis in their esophageal biopsies decreased from 76% to 30% after the elemental diet. In addition, 76% of patients had moderate to severe basal cell hyperplasia before the diet, compared with 12% after the diet.

Esophageal integrity was impaired in EoE patients compared with the healthy controls, but duodenal integrity was not impaired. There was also no significant difference between the L/M ratios of the EoE patients and the healthy controls. The esophageal transepithelial resistance improved after the diet but did not reach values seen in healthy controls.

“This study confirms that dysregulation of filaggrin and desmoglein-1 plays a role in the impaired esophageal barrier function rather than alterations in tight junction proteins,” the study authors wrote. “Finally, our study provides further evidence that impaired duodenal mucosal integrity is not involved in the pathogenesis of EoE.”


  1. Warners MJ, Vlieg-Boerstra BJ, Verheij J, et al. Esophageal and small intestinal mucosal integrity in eosinophilic esophagitis and response to an elemental diet. Am J Gastroenterol. 2017. doi:10.1038/ajg.2017.107