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

Raymenants K, Balsiger LM, Schol J, van de Bruaene C, Tóth J, Dufour D, de Hertogh G, Farré R, Verbeke K, Dieterich W, Zopf Y, Ceulemans M, Verbiest A, Arts J, Wauters L, Vanuytsel T, Tack J (2026)

Publication Type: Journal article

Publication year: 2026

Journal

Journal of Neurogastroenterology and Motility Korean Society of Neurogastroenterology and Motility

Book Volume: 32

Pages Range: 350-361

Journal Issue: 3

DOI: 10.5056/jnm25132

Abstract

Background/Aims: 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. Methods: 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. Results: 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. Conclusions: 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.

Authors with CRIS profile

Walburga Dieterich Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology Yurdagül Zopf Professur für Integrative Medizin mit dem Schwerpunkt Ernährungsmedizin (Stiftungsprofessur der Hector Stiftung II gGmbH)

Involved external institutions

Katholieke Universiteit Leuven (KUL) / Catholic University of Leuven BE Belgium (BE) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven BE Belgium (BE)

How to cite

APA:

Raymenants, K., Balsiger, L.M., Schol, J., van de Bruaene, C., Tóth, J., Dufour, D.,... Tack, J. (2026). Confocal Laser Endomicroscopy With Duodenal Food Challenge Does Not Predict Triggering Food Items in Eosinophilic Esophagitis: Results From a Pilot Trial. Journal of Neurogastroenterology and Motility, 32(3), 350-361. https://doi.org/10.5056/jnm25132

MLA:

Raymenants, Karlien, et al. "Confocal Laser Endomicroscopy With Duodenal Food Challenge Does Not Predict Triggering Food Items in Eosinophilic Esophagitis: Results From a Pilot Trial." Journal of Neurogastroenterology and Motility 32.3 (2026): 350-361.

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