Comparing Two Restrictive Diets for Treating Eosinophilic Esophagitis in Children

Kliewer, Kara; Sun, Qin; Lin, Fang; Abonia, J. Pablo; Aceves, Seema S.; Atkins, Dan; Bonis, Peter A; Chehade, Mirna; Capocelli, Kelley E.; Collins, Margaret; Dellon, Evan S.; Furuta, Glenn T.; Gupta, Sandeep; Kagalwalla, Amir F.; Leung, John; Mukkada, Vincent A.; Pesek, Robbie D.; Spergel, Jonathan M.; Yang, Guang–Yu; Book, Wendy; Strobel, Mary Jo; Kodroff, Ellyn; Kyle, Shay; Reidy, Cathy; Rothenberg, Marc E.

doi:10.25302/04.2020.cer.140311593

Cited by 2 publications

(3 citation statements)

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“…159,160 Another randomised trial involving children with EoE showed that 1FED compared with 4FED resulted in similar rates of histologic remission and slightly lower improvement in symptoms but greater improvement in quality of life. 161 This implies that from a clinical standpoint, it would be reasonable to start with a less restrictive diet, to examine a 1FED or 2FED, assess for response, and then if there is non-response, move to more restrictive diets if a patient is interested. Two main approaches are used in clinical practice which include a top-down approach -beginning with a 6FED and adding a single food/food group back at a timeand a step-up approach -beginning with 1FED or 2FED and removing foods/food groups in intervals.…”

Section: Clinical Trials Identifiermentioning

confidence: 99%

“…Since this time, a randomised trial in adults with EoE randomly assigned to 1FED or 6FED failed to detect a difference in rates of histologic remission between the two groups at 6 weeks (34% vs. 40%, respectively; absolute risk difference: 6%, 95% CI: −11% to 23%) 159,160 . Another randomised trial involving children with EoE showed that 1FED compared with 4FED resulted in similar rates of histologic remission and slightly lower improvement in symptoms but greater improvement in quality of life 161 . This implies that from a clinical standpoint, it would be reasonable to start with a less restrictive diet, to examine a 1FED or 2FED, assess for response, and then if there is non‐response, move to more restrictive diets if a patient is interested.…”

Section: Therapeuticsmentioning

confidence: 99%

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Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

Low,

Dellon

2023

Aliment Pharmacol Ther

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SummaryBackgroundEosinophilic gastrointestinal diseases (EGIDs) are chronic, immune‐mediated disorders characterised clinically by gastrointestinal symptoms and histologically by a pathologic increase in eosinophil‐predominant inflammation in the gastrointestinal tract, in the absence of secondary causes of eosinophilia.AimsTo highlight emerging insights and research efforts into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis (EoE) and non‐EoE EGIDs, and discuss key remaining knowledge gaps.MethodsWe selected and reviewed original research, retrospective studies, case series, randomised controlled trials, and meta‐analyses.ResultsStandardised nomenclature classifies EGIDs as EoE, eosinophilic gastritis (EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). Incidence and prevalence of EoE are rising, emphasising the need to better understand how environmental risk factors and genetic features interact. Advances in understanding EoE pathophysiology have led to clinical trials of targeted therapy and the approval (in the United States) of dupilumab for EoE. Several therapies that are under investigation hope to satisfy both histologic and clinical targets. For non‐EoE EGIDs, efforts are focused on better defining clinical and histopathologic disease determinants and natural history, as well as establishing new therapies.ConclusionsUnmet needs for research are dramatically different for EoE and non‐EoE EGIDs. In EoE, non‐invasive diagnostic tests, clinicopathologic models that determine the risk of disease progression and therapeutic failure, and novel biologic therapies are emerging. In contrast, in non‐EoE EGIDs, epidemiologic trends, diagnostic histopathologic thresholds, and natural history models are still developing for these more rare disorders.

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Section: Clinical Trials Identifiermentioning

confidence: 99%

Section: Therapeuticsmentioning

confidence: 99%

Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

Low,

Dellon

2023

Aliment Pharmacol Ther

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“…Multifood elimination diets are challenging due to the need for strict adherence as well as the requirement for multiple endoscopies to document the efficacy of the diets in reducing esophageal eosinophilia. Studies in children demonstrate that isolated milk elimination can be as successful as FFED [53]. Although combined skin prick and patch testing have had variable success rates, allergy testing-based elimination diets have largely fallen out of favor.…”

Section: Allergies and Eosinophilic Esophagitismentioning

confidence: 99%

The role of the allergist in the management of eosinophilic esophagitis

Woo

Aceves

2021

Current Opinion in Gastroenterology

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Purpose of reviewThe purpose of this review is to provide the current understanding of the role of allergens/antigens, the use of allergy testing, and to elucidate the role of the allergist in the management of eosinophilic esophagitis (EoE).Recent findingsEoE is a T2 immune disorder that is part of the atopic march. EoE patients commonly have multiple concurrent allergic disorders. Recent studies demonstrate that, like other allergic diseases, epithelial barrier dysfunction plays a key role in EoE pathogenesis. Aero- and food allergens have been identified as EoE triggers. EoE management includes the assessment and avoidance of its instigating antigens. Due to the integrated T2 immune response in an allergic individual, proper EoE care should include the control of underlying atopic disorders. EoE is a complex disease that is optimally managed by a multidisciplinary approach.SummaryThis review provides an update on the role of the allergist in the clinical management of EoE.

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Comparing Two Restrictive Diets for Treating Eosinophilic Esophagitis in Children

Cited by 2 publications

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Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

Review article: Emerging insights into the epidemiology, pathophysiology, diagnostic and therapeutic aspects of eosinophilic oesophagitis and other eosinophilic gastrointestinal diseases

The role of the allergist in the management of eosinophilic esophagitis

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