Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis - 31/05/12
Corresponding author: Marc E. Rothenberg, MD, PhD, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 7028, Cincinnati, OH 45229-3039.Abstract |
Background |
Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies are limited.
Objective |
This study compared the effectiveness of 3 frequently prescribed dietary therapies (elemental, 6-food elimination, and skin prick and atopy patch–directed elimination diets) and assessed the remission predictability of skin tests and their utility in directing dietary planning.
Methods |
A retrospective cohort of proton-pump inhibitor–unresponsive, non–glucocorticoid-treated patients with eosinophilic esophagitis who had 2 consecutive endoscopic biopsy specimens associated with dietary intervention was identified. Biopsy histology and remissions (<15 eosinophils/high-power field) after dietary therapy and food reintroductions were evaluated.
Results |
Ninety-eight of 513 patients met the eligibility criteria. Of these 98 patients, 50% (n = 49), 27% (n = 26), and 23% (n = 23) received elemental, 6-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, 6-food elimination, and directed diets, respectively. The odds of postdiet remission versus nonremission were 5.6-fold higher (P = .05) on elemental versus 6-food elimination diets and 12.5-fold higher (P = .003) on elemental versus directed diets and were not significantly different (P = .22) on 6-food elimination versus directed diets. After 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40% to 67% (milk, 40%; egg, 56%; soy, 64%; and wheat, 67%).
Conclusion |
All 3 dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with 6-food elimination and skin test–directed diets. Notably, an empiric 6-food elimination diet is as effective as a skin test–directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin test results.
Le texte complet de cet article est disponible en PDF.Key words : Eosinophilic esophagitis, eosinophils, histologic remission, pediatric, dietary therapy, food allergy, negative predictive values, elemental diet, 6-food elimination diet, skin test–directed elimination diet
Abbreviations used : APT, CCED, CCHMC, EGID, EGD, EoE, hpf, NPV, SFED, SPT
Plan
| Supported by the Campaign Urging Research for Eosinophilic Disease (CURED), the Buckeye Foundation, the International Group of Eosinophilic Researchers (TIGER), an Institutional Clinical and Translational Science Award, and National Institutes of Health (NIH)/National Center for Research Resources grant no. 5UL1RR026314. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. |
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| Disclosure of potential conflict of interest: J. P. Abonia has received research support from the National Institutes of Health (NIH), Ception Therapeutics, and the Children’s Digestive Health and Nutrition Foundation. M. E. Rothenberg has an equity interest in Teva Pharmaceutical Industries’ reslizumab; is Chief Scientific Officer of Immune Pharmaceuticals; is inventor of several patents related to EoE that are being considered for commercial development; is on the American Partnership for Eosinophilic Disorders Medical Advisory Board; and is on the Steering Committee of the International Eosinophil Society (IES) and the International Group of Eosinophilic Researchers (TIGER). The rest of the others declare that they have no relevant conflicts of interest. |
Vol 129 - N° 6
P. 1570-1578 - juin 2012 Retour au numéro
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