Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study - 05/04/18
, Ángel Arias, MSc, BSc b, c, Javier Alcedo, MD, PhD d, Ruth Garcia-Romero, MD, PhD e, Sergio Casabona-Frances, MD f, Alicia Prieto-Garcia, MD, PhD g, Ines Modolell, MD, PhD h, Pedro L. Gonzalez-Cordero, MD a, Isabel Perez-Martinez, MD, PhD i, Jose Luis Martin-Lorente, MD, PhD j, Carlos Guarner-Argente, MD, PhD k, Maria L. Masiques, MD l, Victor Vila-Miravet, MD m, Roger Garcia-Puig, MD n, Edoardo Savarino, MD, PhD o, Carlos Teruel Sanchez-Vegazo, MD p, Cecilio Santander, MD, PhD b, f, Alfredo J. Lucendo, MD, PhD b, q, ⁎ Abstract |
Background |
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.
Objective |
We sought to assess the effectiveness of a step-up dietary strategy for EoE.
Methods |
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.
Results |
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%.
Conclusions |
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.
Le texte complet de cet article est disponible en PDF.Key words : Eosinophilic esophagitis, diet, milk, wheat, six-food elimination
Abbreviations used : DSS, EoE, FFGED, hpf, IQR, PPI, SFGED, TFGED
Plan
| Disclosure of potential conflict of interest: E. Savarino has consultant arrangements with Abbvie, MSD, Takeda, Malesci, and Sofar. C. T. Sanchez-Vegazo has received payment for lectures from Norgine and has received travel support from Norgine, Bama-Geve, and Allergan. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 141 - N° 4
P. 1365-1372 - avril 2018 Retour au numéro
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