At the ACG Annual Scientific Meeting, researchers led by Evan S. Dellon presented results from a 44-patient randomized trial evaluating Immune-Directed Individualized Elimination Therapy (iDIET) for eosinophilic esophagitis. By targeting food-specific IgG4 and blood T-cell responses across an 18-food panel, iDIET significantly reduced peak eosinophil counts (57.9 vs. 116.4 eosinophils/hpf) and boosted endoscopic response rates (36% vs. 9%) compared to a sham diet at week 8.
Histologic and endoscopic trial results
- ▪At the ACG Annual Scientific Meeting in October 2026, findings showed Immune-Directed Individualized Elimination Therapy (iDIET) reduced 8-week post-treatment peak eosinophil counts to 57.9 versus 116.4 eosinophils per high-power field for sham diet in eosinophilic esophagitis.
- ▪Patients on the iDIET protocol achieved a 36% endoscopic response rate at week 8 compared to 9% for those on the sham diet in the clinical trial presented by Evan S. Dellon.
- ▪The randomized clinical trial showed greater reductions from baseline in endoscopic and histologic severity scores for the iDIET group, though no statistically significant difference in histologic response was observed between iDIET and sham diet groups.
Trial design and iDIET development
- ▪The randomized, double-blind, sham-controlled iDIET trial enrolled 44 patients with confirmed eosinophilic esophagitis who were assigned to follow either the iDIET regime or a sham elimination diet for 8 weeks.
- ▪Researchers led by Evan S. Dellon developed iDIET using allergen-specific immune signatures based on food-specific IgG4 in esophageal biopsies and peripheral blood T-cell stimulation across an 18-food panel.
Dysphagia symptom assessment
- ▪In the randomized iDIET trial, both the iDIET treatment group and the sham diet control group experienced comparable improvements in dysphagia symptoms after 8 weeks.
- ▪Researchers did not power the randomized iDIET clinical trial to assess a statistical difference in symptom outcomes between study groups.
iDIET feasibility and future steps
- ▪Planned next steps for iDIET research involve optimizing cut-off values for food triggers and testing the protocol in a larger patient population.
- ▪The initial randomized trial achieved its primary goal of demonstrating the feasibility of implementing the iDIET protocol in a clinical setting.
Patient demographics and procedures
- ▪Baseline demographics and disease characteristics were balanced between patient groups enrolled in the randomized iDIET clinical trial.
- ▪In the iDIET clinical trial presented at the ACG Annual Scientific Meeting, approximately 75% of total enrolled eosinophilic esophagitis patients underwent esophageal dilation during the study period.
Limitations of conventional food trigger identification
- ▪Identifying food triggers for eosinophilic esophagitis conventionally requires multiple endoscopic procedures during a food reintroduction process following empiric dietary elimination.
- ▪Traditional skin prick, patch, and serum IgE allergy tests do not accurately identify specific food triggers for eosinophilic esophagitis, according to medical guidelines noted by Evan S. Dellon at the ACG Annual Scientific Meeting.
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