If neither a novel protein diet nor a hydrolyzed diet yields improvement, what is the typical next conclusion?

• A. The condition is not food-related.
• B. A different hydrolyzed diet should be tried.
• C. Antibiotics are necessary.
• D. Surgery is required.

Answer: (A)

Elimination diet trials are used to see if symptoms are driven by dietary antigens. Improvement on a novel protein diet or on a hydrolyzed diet points to a food-responsive issue, because those approaches minimize exposure to intact dietary proteins. If neither diet yields improvement, it strongly suggests the problem isn’t food-related, so the usual next step is to pursue non-dietary causes and diagnostic workup (such as inflammatory bowel disease, infections, parasites, or other intestinal diseases). A trial of a different hydrolyzed diet or antibiotics or surgery isn’t the typical immediate conclusion once dietary trials fail, since the primary implication is that diet isn’t the culprit and other etiologies should be explored.