877 Prospective Trial of Four Food Elimination Diet Demonstrates Comparable Effectiveness in the Treatment of Adult and Pediatric Eosinophilic Esophagitis

Gonsalves, Nirmala; Doerfler, Bethany; Schwartz, Sally; Yang, Guang–Yu; Zalewski, Angelika; Amsden, Katie; Mughal, Sabena; Manuel-Rubio, Maria; Melín-Aldana, Héctor; Wershil, Barry K.; Hirano, Ikuo; Kagalwalla, Amir F.

doi:10.1016/s0016-5085(13)60552-1

Cited by 27 publications

(28 citation statements)

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“…Histologic remission (peak eos count <10 eos/hpf) was documented in 46% and 60% of adult and pediatric patients, respectively. 24 Our series represents one of the largest in adults after the previous Spanish study 17 and, of note, reintroduction food challenge was completed in the bulk of FFGED responders. Concordances in effectiveness rates and the type of involved foods for empiric SFGED and FFGED elimination diets among American and European studies may be due to the many similarities of staple diets in both regions, which share a common cultural and dietary background.…”

Section: Discussionmentioning

confidence: 96%

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study

Molina–Infante

Arias²,

Barrio

et al. 2014

Journal of Allergy and Clinical Immunology

211

132

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Section: Discussionmentioning

confidence: 96%

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study

Molina–Infante

Arias²,

Barrio

et al. 2014

Journal of Allergy and Clinical Immunology

211

132

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“…156 Therefore, the efficacy of empiric diets requiring elimination of fewer food groups is also under investigation. 160 …”

Section: Treatmentmentioning

confidence: 99%

Advances in Clinical Management of Eosinophilic Esophagitis

2014

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EoE is a chronic immune/antigen-mediated clinicopathologic condition that has become an increasingly important cause of upper gastrointestinal morbidity in adults and children over the past 2 decades. It is diagnosed based on symptoms of esophageal dysfunction, the presence of at least 15 eosinophils/high-power field in esophageal biopsies, and exclusion of competing causes of esophageal eosinophilia, including proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). We review what we have recently learned about the clinical aspects of EoE, discussing the clinical, endoscopic, and histologic features of EoE in adults and children. We explain the current diagnostic criteria and challenges to diagnosis, including the role of gastroesophageal reflux disease and PPI-REE. It is also important to consider the epidemiology of EoE (current incidence of 1/10,000 new cases per year and prevalence of 0.5-1/1,000 cases per year) and disease progression. We review the main treatment approaches and new treatment options; EoE can be treated with topical corticosteroids such as fluticasone and budesonide, or dietary strategies, such as amino acid-based formulas, allergy test-directed elimination diets, and non-directed empiric elimination diets. Endoscopic dilation has also become an important tool for treatment of fibrostenostic complications of EoE. There are number of unresolved issues in EoE, including phenotypes, optimal treatment endpoints, the role of maintenance therapy, and treatment of refractory EoE. The care of patients with EoE and the study of the disease span many disciplines—EoE is ideally managed by a multidisciplinary team of gastroenterologists, allergists, pathologists, and dieticians.

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“…For example, it is not known if complete histologic normalization of the esophageal mucosa is the most clinically relevant outcome, or whether lower levels of inflammation are acceptable, and if so, what level. Previous studies have used variable cutpoints (from <15 eos/hpf to 0 eos/ hpf) or have relied on percentage change in eosinophil counts [3,7,8] . Other researchers have proposed endoscopic end points such as the eosinophilic esophagitis endoscopic reference score (EREFS) or have used symptomatic improvement as the target [9][10][11] .…”

mentioning

confidence: 99%

Evaluation of Histologic Cutpoints for Treatment Response in Eosinophilic Esophagitis

Wolf

Cotton

Green

et al. 2015

Journal of Gastroenterology and Hepatology Research

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and endoscopic response at several possible eosinophil count cutpoints (eos/hpf). Predictors of response were also assessed. RESULTS: Of 224 treatments in 199 patients, 76% were associated with symptomatic improvement, 68% with endoscopic improvement, and 60% with both. Of treatments that resulted in a post-treatment count of <15 eos/hpf, 90% were associated with an endoscopic response, 88% with a symptomatic response, and 81% with both symptomatic and endoscopic responses. Using a <15 eos/hpf threshold, the area under the curves (AUCs) were 0.70, 0.78, and 0.75 for symptomatic, endoscopic, and symptomatic/endoscopic responses, respectively. Lower histologic cut-points did not result in a substantial gain in response, but decreased the AUC. CONCLUSION: In this large cohort of EoE patients, rates of symptomatic and endoscopic improvement were generally associated with histologic improvement. A histologic cutoff for treatment response of <15 eos/hpf may balance clinical outcomes and test performance. Journal of Gastroenterology and Hepatology Researchendoscopist-reported assessment of improvement [yes/no]), and both symptom and endoscopic response. Data AnalysisAll data were analyzed using SAS version 9.3 (Cary, NC). Bivariate analyses were performed with chi-square testing for categorical variables. Because all continuous variables were not normally distributed, the Wilcoxon two-tailed t approximation (rank-sum) was used. For evaluation of treatment outcomes, a per-treatment analysis was performed, allowing inclusion of both outcomes for patients who underwent separate courses of steroid and dietary therapy. Receiver operator characteristic (ROC) curves were generated and the area under the curve (AUC) was calculated for multiple values of the post-treatment eosinophil count (eos/hpf) as well as for the percentage change in the eosinophil count compared to baseline. Because dilation can produce symptomatic improvement without endoscopic or histologic improvement, we conducted a subgroup analysis among patients not undergoing dilation at baseline (prior to treatment) to evaluate outcomes. For patients treated with tCS, those with concordant symptomatic, endoscopic, and histologic response (<15 eos/hpf) were compared to those without using a bivariate analysis. For inclusion in this portion of the analysis, patients had to have recorded symptomatic and endoscopic response variables and pre-and post-treatment eosinophil counts. A logistic regression model was constructed to assess predictors of concordant response by including all variables significant at the p<0.2 level and then reducing until all factors were significant at the p<0.05 level. This study was approved by the UNC Institutional Review Board. RESULTSWe identified 199 patients with EoE meeting inclusion criteria. The mean age was 27, and they were predominately white (84%), male (68%), and had a history of atopic disease (52%) ( Table 1). Eightythree percent were adults (≥18 years old) at the time of diagnosis. The predominant baseline symptom was dysp...

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877 Prospective Trial of Four Food Elimination Diet Demonstrates Comparable Effectiveness in the Treatment of Adult and Pediatric Eosinophilic Esophagitis

Cited by 27 publications

References 0 publications

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study

Four-food group elimination diet for adult eosinophilic esophagitis: A prospective multicenter study

Advances in Clinical Management of Eosinophilic Esophagitis

Evaluation of Histologic Cutpoints for Treatment Response in Eosinophilic Esophagitis

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