Details

Autor(en) / Beteiligte

• Molina-Infante, Javier
• Arias, Ángel
• Alcedo, Javier
• Garcia-Romero, Ruth
• Casabona-Frances, Sergio
• Prieto-Garcia, Alicia
• Modolell, Ines
• Gonzalez-Cordero, Pedro L.
• Perez-Martinez, Isabel
• Martin-Lorente, Jose Luis
• Guarner-Argente, Carlos
• Masiques, Maria L.
• Vila-Miravet, Victor
• Garcia-Puig, Roger
• Savarino, Edoardo
• Sanchez-Vegazo, Carlos Teruel
• Santander, Cecilio
• Lucendo, Alfredo J.

Titel

Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study

Ist Teil von

• Journal of allergy and clinical immunology, 2018-04, Vol.141 (4), p.1365-1372

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2018

Link zum Volltext

Quelle

EZB Electronic Journals Library

Beschreibungen/Notizen

• Numerous dietary restrictions and endoscopies limit the implementation of empiric elimination diets in patients with eosinophilic esophagitis (EoE). Milk and wheat/gluten are the most common food triggers. We sought to assess the effectiveness of a step-up dietary strategy for EoE. We performed a prospective study conducted in 14 centers. Patients underwent a 6-week 2-food-group elimination diet (TFGED; milk and gluten-containing cereals). Remission was defined by symptom improvement and less than 15 eosinophils/high-power field. Nonresponders were gradually offered a 4-food-group elimination diet (FFGED; TFGED plus egg and legumes) and a 6-food-group elimination diet (SFGED; FFGED plus nuts and fish/seafood). In responders eliminated food groups were reintroduced individually, followed by endoscopy. One hundred thirty patients (25 pediatric patients) were enrolled, with 97 completing all phases of the study. A TFGED achieved EoE remission in 56 (43%) patients, with no differences between ages. Food triggers in TFGED responders were milk (52%), gluten-containing grains (16%), and both (28%). EoE induced only by milk was present in 18% and 33% of adults and children, respectively. Remission rates with FFGEDs and SFGEDs were 60% and 79%, with increasing food triggers, especially after an SFGED. Overall, 55 (91.6%) of 60 of the TFGED/FFGED responders had 1 or 2 food triggers. Compared with the initial SFGED, a step-up strategy reduced endoscopic procedures and diagnostic process time by 20%. A TFGED diet achieves EoE remission in 43% of children and adults. A step-up approach results in early identification of a majority of responders to an empiric diet with few food triggers, avoiding unnecessary dietary restrictions, saving endoscopies, and shortening the diagnostic process.