How can dietary trials help differentiate FRD from ARE/IRE?

• A. FRD shows marked improvement on hydrolyzed/novel protein diet; ARE/IRE may require antibiotics or immunosuppressants and may not have diet-only response.
• B. ARE/IRE may require antibiotics or immunosuppressants but FRD does not.
• C. FRD responds only to antibiotics; ARE/IRE responds to diet.
• D. Diet trials cannot differentiate FRD from ARE/IRE.

Answer: (B)

The main concept is using a dietary trial to see if the disease responds to diet alone, which helps separate food-responsive disease from antibiotic- or immunosuppressant-responsive enteropathy. In food-responsive disease, a hydrolyzed or novel-protein diet often leads to marked improvement without needing antibiotics or immunosuppressants. By contrast, antibiotic- or immunosuppressant-responsive enteropathy typically does not show a durable, diet-only response and may require targeted pharmacologic therapy. So, observing that ARE/IRE may need antibiotics or immunosuppressants while FRD does not is the key distinction dietary trials aim to reveal.