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THE EFFECT OF THE 6-FOOD ELIMINATION DIET FOR THE TREATMENT OF EOSINOPHILIC ESOPHAGITIS ON URINE AND BLOOD PLASMA METABOLOMIC PROFILE IN HEATHY VOLUNTEERS

Peter Liptak 1, Eva Baranovicova 1, Sophia Christine Lilgova 1, Katarina Dirnbachova 1, Margareta Graňák Pytliaková 1, Martin Ďuriček 1, Peter Banovcin 1

Affiliations

1 Jessenius Faculty of Medicine in Martin, Comenius University, Martin, Slovakia

Summary

AI Generated

A prospective study of 15 healthy volunteers found that a 4-week 6-food elimination diet (eliminating eggs, dairy, seafood, nuts, wheat, and soy) produced only minor metabolomic changes and no significant impact on anthropometric measures or quality of life.

Blood plasma showed significant increases in acetate, succinate, creatine, and creatinine after 4 weeks, while urine showed decreased dimethylamine; essential amino acid levels remained unchanged.
No relevant differences were observed in anthropometric parameters including BMI, fat mass, or muscle mass.
Quality of life questionnaires (WHOQOL-BREF, PROMIS-10, PHQ-15) showed no significant changes during the 4-week dietary restriction period.
The 6-food elimination diet is used to treat eosinophilic esophagitis, particularly in patients who cannot tolerate corticosteroids, though the disease cause remains unknown.
This material would be most relevant to gastroenterologists managing eosinophilic esophagitis and dietitians counseling patients on elimination diets.

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Abstract

Introduction

Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disease of esophagus characterized by a significant mucosal eosinophilia. However, the definite cause of this disease remains unknown. One of the most probable etiology factors is an abnormal response of immune system to various types of ingested food. Therefore, one of the treatment options is the so called 6-food elimination diet. This diet represents a therapeutic method of choice especially in patients who could not be treated by standard immunosuppressive medications such as corticosteroids. The 6 food groups that are mostly associated with food allergies are: eggs, dairy products, seafood/shellfish, nuts, wheat, and soy. Although widely used, there is surprisingly lack of data evaluating its effect on metabolomic profile of the patients and their well-being despite its strict dietary regime.

Aims & Methods

The aim of this study was to evaluate possible changes in metabolomic and anthropometric parameters in healthy individuals pre and after 4 weeks of elimination diet.
We performed a prospective single center study on healthy volunteers (age >18 years). For metabolomic analysis of blood plasma and urine the method of NMR (Nuclear Magnetic Resonance) was used. Anthropometric analysis was performed by bioelectrical impedance. All volunteers also filled validated questionnaires considering various aspects of patient well-being (WHOQOL-BREF, PROMIS-10 and PHQ-15). The statistical analysis was processed by unparametric tests (Mann-Whitney U-test) for comparison of equality of medians and unparametric paired Wilcoxon-signed-rank test.

Results

Fifteen (15) healthy volunteers without any previous dietary restrictions participated in this study (12 women with median age 35,5 years and 3 men with median age 41 years). Evaluation of blood plasma metabolomic profile shows significant increase of acetate, succinate, creatine, and creatinine at the end of the four weeks period of the course of the diet. The urine metabolomic profile shows significant decrease of dimethylamine. Importantly, no statistically significant changes were observed in the levels of essential aminoacids. No relevant differences were observed considering anthropometric parameters (BMI, percentage of fat and muscle mass) and in the questionnaires assessing quality of life.

Conclusion

The results of presented study shows that the 6-food elimination diet have only minor effect on the metabolomic profile of healthy volunteers. This further suggest its good safety profile for the treatment of eosinophilic esophagitis. In addition, presented data point out that this diet does not significantly lower the quality of life of patients which could result to good adherence to the diet in short term course.

Conference

UEG Week Copenhagen 2023

Topics

Oesophagus

Submission format

Abstract

Session

PP 01 Oesophageal, gastric and duodenal disorders (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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Compensated advanced chronic liver disease and clinically significant portal hypertension: From non-invasive diagnosis to treatment

Annalisa Berzigotti 1

Affiliations

1 Inselspital, University Hospital of Berne, Berne, Switzerland

Summary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Digestive Oncology Radiology & Imaging Small Intestine & Nutrition Hepatobiliary

Session

Advanced chronic liver disease: When the liver gets stiff, the complications get going

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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MASLD with Sven Francque - Part 1

Sven Francque, Pradeep Mundre

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Abstract

Topics

Hepatobiliary

Published

2026

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Summary: Advanced chronic liver disease: When the liver gets stiff, the complications get going

Mária Papp 1

Affiliations

1 University of Debrecen, Debrecen, Hungary

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Abstract

Event

Postgraduate Teaching Programme Barcelona 2026

Topics

Digestive Oncology Radiology & Imaging Small Intestine & Nutrition Hepatobiliary

Session

Advanced chronic liver disease: When the liver gets stiff, the complications get going

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

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2026

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THE PEPPER TRIAL: WHAT TO EXPECT WHEN STOPPING CHRONIC PROTON PUMP INHIBITOR THERAPY IN PRIMARY CARE PATIENTS

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THE PEPPER TRIAL: WHAT TO EXPECT WHEN STOPPING CHRONIC PROTON PUMP INHIBITOR THERAPY IN PRIMARY CARE PATIENTS

Janne Scheepers 1, Karen Van den Houte 1, Annouschka Laenen 1, Jan Tack 2, Florencia Carbone 1

Affiliations

1 KU Leuven, Leuven, Belgium

2 University of Leuven, University Hospital Gasthuisberg, Leuven, Belgium

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Abstract

Introduction

Inappropriate long‑term use of proton pump inhibitors (PPIs) is common, with up to 82% of chronic prescriptions lacking a valid indication. Treatment is rarely tapered or discontinued once initiated. A key barrier to deprescribing is the (re-)occurrence of gastrointestinal symptoms, which often leads to treatment resumption. Moreover, insight into the long‑term evolution of individual symptoms following PPI discontinuation is lacking.

Aims & Methods

This study aimed to characterize the expected evolution of gastrointestinal symptoms during and after PPI deprescribing in primary care. In this pragmatic clinical trial, 61 general practitioners recruited and randomised patients to one of three PPI deprescribing strategies. After following the assigned strategy for 1 month, patients were requested to stop PPI use and were followed up for 1 year. Gastrointestinal symptom severity (PAGI-SYM) and quality of life (PAGI-QOL) were assessed at all timepoints. Antacids were allowed as rescue therapy throughout the trial. Successful patients were defined as limited those with PPI use (<4 doses per month) and willingness to continue their current treatment, from follow-up onward. Linear mixed models were used. Random effects were modelled to deal with the longitudinal data structure. The fixed effect model included time, group and time by group interactions. Analyses were performed on an ITT basis. Results are presented as mean±SD or median (IQR).

Results

627 patients were randomized (60±14 years old, BMI 28±5kg/m², 60% female, median PPI use 9 (5-15) years). Following initiation of the deprescribing strategies, a transient increase in upper gastrointestinal symptoms was observed after one month of deprescribing. Compared to baseline, overall symptom severity increased significantly (p<0.0001), driven by worsening heartburn, nausea, postprandial fullness, early satiation, and upper abdominal pain (all p<0.0001). This increase was driven mainly by the increased symptom severity in unsuccessful patients, as the overall symptom severity did not increase in the successful patients. Notably, bloating severity decreased significantly from the month of deprescribing onward (p<0.0001) and continued to decline, resulting in lower bloating scores throughout the entire follow‑up period compared with baseline. During the follow-up period, overall PAGI‑SYM scores improved to below baseline levels (p<0.0001). Postprandial fullness and early satiation improved significantly from 3 months follow-up onward (p=0.0005), accompanied by improvement in lower abdominal pain (p=0.0060). Upper abdominal pain decreased significantly from 6 months follow-up onward (p=0.0047). No significant differences in symptom pattern are seen based on the initial PPI indication. Quality of life improved from the follow-up period onward (p<0.0001).

Conclusion

PPI deprescribing in long‑term users is associated with a short‑term transient increase in upper gastrointestinal symptoms, followed by progressive and sustained symptom improvement over time. Quality of life and multiple symptom domains improve beyond baseline at follow‑up. These findings confirm the feasibility of PPI deprescribing and provide relevant insights for patient counselling and expectation management during deprescribing phases.

Event

UEG Week Barcelona 2026

Topics

Stomach & H. Pylori Oesophagus

Submission format

Abstract

Session

Anti-secretory therapy: Evolving standards and future horizons

Citation

2026: United European Gastroenterology Journal 2026; 14 (S1)

Published

2026

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Summary

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Abstract

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Physician Wellbeing

Martina Müller-Schilling, Egle Dieninyte - Misiune

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Abstract

Published

2024

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