Empiric 6-food elimination diet induced and maintained prolonged remission in patients with adult eosinophilic esophagitis: A prospective study on the food cause of the disease - 27/02/13
, Ángel Arias, BSc, MSc b, Jesús González-Cervera, MD c, José Luis Yagüe-Compadre, MD d, Danila Guagnozzi, MD a, Teresa Angueira, MD a, Susana Jiménez-Contreras, MD a, Sonia González-Castillo, MD a, Benito Rodríguez-Domíngez, MD c, Livia C. De Rezende, MD, PhD a, José M. Tenias, MD, PhD b
Corresponding author: Alfredo J. Lucendo, MD, PhD, FEBG, Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n, 13700 Tomelloso, Spain.Abstract |
Background |
Although empiric exclusion from the diet of the 6 food groups most likely to trigger allergies achieves eosinophilic esophagitis (EoE) remission in children, data on its prolonged efficacy and effects on adults are lacking.
Objective |
We sought to evaluate the efficacy of a 6-food elimination diet in inducing and maintaining prolonged remission in patients with adult EoE.
Methods |
Sixty-seven consecutive patients with adult EoE were prospectively recruited and treated exclusively with a diet avoiding cereals, milk, eggs, fish/seafood, legumes/peanuts, and soy for 6 weeks. Subsequent challenge was undertaken by sequentially reintroducing all excluded single foods, followed by endoscopy and biopsies, which were developed every 6 weeks in case of response (eosinophil peak count reduction to <15/high-power field [hpf]). A food was considered a trigger for EoE and removed from the diet if pathologic eosinophilic infiltration (≥15 eosinophils/hpf) reappeared. Food-specific serum IgE measurements and skin prick tests were performed before initiating the diet.
Results |
Forty-nine (73.1%) patients exhibited significantly reduced eosinophil peak counts (<15 eosinophils/hpf) before sequential single-food reintroduction. A single offending food antigen was identified in 35.71% of patients, 2 food triggers were identified in 30.95%, and 3 or more food triggers were identified in 33.3%. Cow’s milk was the most common food antigen (61.9%), followed by wheat (28.6%), eggs (26.2%), and legumes (23.8%). Prior allergy tests showed no concordance with food-reintroduction challenge results. All patients who continued to avoid the offending foods maintained histopathologic and clinical EoE remission for up to 3 years.
Conclusions |
An empiric 6-food elimination diet effectively induced remission of active adult EoE, which was maintained for up to 3 years with individually tailored, limited exclusion diets.
Le texte complet de cet article est disponible en PDF.Key words : Eosinophilic esophagitis, 6-food elimination diet, therapy, treatment, food allergy, remission
Abbreviations used : EoE, hpf, IQR, PPI, SFED, SPT
Plan
| Supported in part by grants from the Association of Biomedical Research La Mancha Centro (Asociación de Investigación Biomédica La Mancha Centro). |
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| Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest. |
Vol 131 - N° 3
P. 797-804 - mars 2013 Retour au numéro
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