Introduction Patients with eosinophilic oesophagitis (EOE) are currently treated with medication (proton pump inhibitors (PPI)/topical steroids), diet restriction and dilation. Diet therapy consists of dietary exclusion of specific foods. A ‘step-up’ approach is usually recommended, considering empirical 1–2 food (milk ± wheat) exclusions then 4-food (additional elimination of soya and egg), then 6-food (with additional elimination of nuts and seafood). Once in remission, individual reintroductions with endoscopic reassessment, helps guide the minimum number of food exclusions required to maintain this. At Great Ormond Street Hospital (GOSH), the GIANTS (gastro-intestinal, allergy, nutrition and therapy service) was a new service initiated in March 2018, managing all existing and newly diagnosed EOE patients at GOSH. This service evaluation project aimed to explore the most common strategies in dietary exclusions and how this impacted on growth and remission of EOE within our cohort.

Methods Retrospective electronic patient records review from March 2018-March 2020. Newly diagnosed patients on diet therapy under GIANTS were included. Patients who had been diagnosed prior to the inception of GIANTS and those with significant comorbidities e.g. trachea-oesophageal fistula were excluded.

Results There were 13 newly diagnosed patients (excluding those with comorbidities) with EOE in the GIANTS service. Of these patients, four patients (30%) completed diet therapy. One patient was unable to complete a milk exclusion and chose medicinal therapy. Children were 3 female, 1 male with a mean age of 7.4 years at diagnosis. Two patients commenced a milk free diet, one had a milk and soya free diet and the fourth had a milk, wheat and soya free diet. Three of four of these patients achieved remission. Three of four patients had trialled drug therapy (PPI) first with no histological remission. BMI z-score did not change between when the children were first diagnosed to achieving disease remission (mean BMI z-score -0.28 to -0.29). All patients had regular access to a dietitian.

Conclusion In this small service evaluation, medicine was the preferred treatment choice for families. This is likely due to the burden of changing the diet has on a family and a patient’s quality of life. However, 75% of this cohort achieved histological remission on diet therapy. PPI appeared ineffective in this small patient group. Empirical food elimination via a step-up approach appears helpful in these patients, reducing burden of excessive exclusions and also reduced number of endoscopies when considering reintroduction of these foods. Growth appeared unaffected with no concerns with BMI. All patients on diet therapy had regular input with the dietitian, supporting the need for specialised dietetic input within gastrointestinal allergy. Whilst these findings are supported in the guidelines, more research is needed to look at which diet strategy is the most effective and how this is achieved, including how many previous treatments and endoscopies a patient has required. Achieving remission rates as timely as possible is crucial not only for the patient’s quality of life but also to reducing the need for repeated endoscopies within short time-frames.