Document Detail


Elimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors.
MedLine Citation:
PMID:  22391333     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Adults with eosinophilic esophagitis (EoE) typically present with dysphagia and food impaction. A 6-food elimination diet (SFED) is effective in children with EoE. We assessed the effects of the SFED followed by food reintroduction on the histologic response, symptoms, and quality of life (QOL) in adults with EoE. METHODS: At the start of the study, 50 adults with EoE received esophagogastroduodenoscopies (EGDs), biopsies, and skin-prick tests for food and aeroallergens. After 6 weeks of SFED, patients underwent repeat EGD and biopsies. Histologic responders, defined by ≤5 eosinophils/high-power field (eos/hpf, n=32), underwent systematic reintroduction of foods followed by EGD and biopsies (n=20). Symptom and QOL scores were determined before and after SFED. RESULTS: Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%). The mean peak eosinophil counts in proximal esophagus were 34 eos/hpf and 8 eos/hpf, before and after the SFED, and 44 eos/hpf and 13 eos/hpf in distal esophagus, respectively (P<.0001). After the SFED, 64% of patients had peak counts ≤5 eos/hpf and 70% had peak counts of ≤10 eos/hpf. Symptom scores decreased in 94% (P<.0001). Following food reintroduction, esophageal eosinophil counts returned to pretreatment values (P<.0001). Based on reintroduction, the foods most frequently associated with EoE were wheat (60% of cases) and milk (50% of cases). Skin-prick testing predicted only 13% of foods associated with EoE. CONCLUSIONS: An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults. Food reintroduction re-initiated features of EoE in patients, confirming a role for food allergens in its pathogenesis. Foods that activated EoE were identified by systematic reintroduction analysis but not by skin-prick tests.
Authors:
Nirmala Gonsalves; Guang-Yu Yang; Bethany Doerfler; Sally Ritz; Anne M Ditto; Ikuo Hirano
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-2
Journal Detail:
Title:  Gastroenterology     Volume:  -     ISSN:  1528-0012     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-6     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
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