Confocal Laser Endomicroscopy With Duodenal Food Challenge Does Not Predict Triggering Food Items in Eosinophilic Esophagitis: Results From a Pilot Trial.

Authors

Karlien Raymenants, Lukas M Balsiger, Jolien Schol, Cedric Van de Bruaene, Joran Tóth, Daphne Dufour, Gert De Hertogh, Ricard Farré, Kristin Verbeke, Walburga Dieterich, Yurdagül Zopf, Matthias Ceulemans, Astrid Verbiest, Joris Arts, Lucas Wauters, Tim Vanuytsel, Jan Tack

Published in

Journal of neurogastroenterology and motility. Volume 32. Issue 3. Pages 350-361. Jul 30, 2026.

Abstract

: Targeted elimination of triggering food items is an attractive treatment option in eosinophilic esophagitis (EoE). However, no reliable biomarkers exist to identify culprit foods. In a previous uncontrolled study, 6/9 responded to duodenal food challenge (DFC), visualized by confocal laser endomicroscopy (CLE). This study aims to assess efficacy of a targeted elimination diet based on identification of nutrients that trigger acute mucosal alterations in the duodenum compared to a sham diet.
: Randomized double-blind cross-over study in EoE. After baseline endoscopy, patients with peak eosinophil count of > 15 eosinophils/high power field underwent CLE. Following baseline assessment, a solution of foods (grains/milk/egg/soy/fish/nuts) was sprayed on the duodenal mucosa, with repeat imaging thereafter. Mucosa was judged as altered in case of fluorescein leakage and particle shedding. Based on the results, patients underwent a blinded randomized 6-week cross-over elimination diet with follow-up endoscopy. Exploratory measurements were done for small intestinal permeability, eosinophil- and mast cell activation.
: Seven patients completed the study. At CLE, 1 patient displayed baseline alterations, 5 reacted to 1 to 2 nutrients in 2 sessions (milk = 4, grains = 2, nuts = 2, fish = 1). There was no association between CLE results, and presence of food-specific IgE (P > 0.999). Both dietary arms resulted in a similar histological response (P > 0.999), with histological remission in only 1 patient (excluding gluten-containing grains). Permeability, eosinophil or mast cell activation were not different between arms.
: In this pilot blinded cross-over trial, a targeted elimination diet based on the results of CLE with DFC did not generate a superior response compared to a sham diet.

PMID:
42504652
Bibliographic data and abstract were imported from PubMed on 27 Jul 2026.

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