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. 2017 Nov;46(9):836-844.
doi: 10.1111/apt.14290. Epub 2017 Sep 6.

Food elimination diets are effective for long-term treatment of adults with eosinophilic oesophagitis

C C Reed  1 , C Fan  1 , N T Koutlas  1 , N J Shaheen  1 , E S Dellon  1
Affiliations

Food elimination diets are effective for long-term treatment of adults with eosinophilic oesophagitis

C C Reed et al. Aliment Pharmacol Ther. 2017 Nov.

Abstract

Background: Limited data describe the long-term efficacy of dietary elimination in eosinophilic oesophagitis (EoE).

Aim: To assess the long-term outcomes of food elimination diets for treatment of adults with EoE.

Methods: We conducted a retrospective cohort study at our centre analysing all EoE patients receiving a food elimination diet without concomitant steroids. Baseline data were abstracted using standardised collection forms. Follow-up data from a mean 24.9-month period were collected for patients with a histological response to a food elimination diet during and after food reintroduction. The main outcomes were symptomatic, endoscopic and histological responses.

Results: Of 52 patients, 18 received a 6-food food elimination diet, 32 received targeted diet, and two received a 6-food food elimination diet with targeted elimination. There were 21 (40%) patients with an initial histological response. Responders reported less dysphagia after treatment (95% baseline vs 11%; P = .001) and at the end of follow-up (95% baseline vs 33%; P = .008). Significant and durable endoscopic improvements were recorded at the same time points: Endoscopic reference score: 3.2 vs 0.7; P = .001; and 3.2 vs 1.7; P = .06. Histological findings improved after the most restrictive diet in responders (49.8 vs 4.1 eosinophils per high-power field; P = .001) and remained suppressed in the 10 initial responders maintaining compliance at the end of follow-up (5.2 eosinophils per high-power field).

Conclusions: Among EoE patients responding to a food elimination diet and remaining adherent, maintenance dietary therapy produced durable long-term symptomatic, endoscopic and histological disease control. These long-term data confirm that a food elimination diet is an effective maintenance treatment option in select adults with EoE.

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Conflict of interest statement

None of the authors have potential conflicts related to the current manuscript.

Figures

Figure 1
Figure 1
Patient flow depiction throughout the treatment period.
Figure 2
Figure 2
(A) Symptom reporting across the study period for included patients receiving food elimination diets (FED). (B) EREFS score across the study period for included patients receiving food elimination diets (FED)
Figure 2
Figure 2
(A) Symptom reporting across the study period for included patients receiving food elimination diets (FED). (B) EREFS score across the study period for included patients receiving food elimination diets (FED)
Figure 3
Figure 3
Histologic findings across the study period for patients receiving food elimination diets (FED)
Figure 4
Figure 4
Number of patients with a particular identified food allergen.
See this image and copyright information in PMC

Comment in

References

    1. Dellon ES, Gonsalves N, Hirano I, et al. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE) Am J Gastroenterol. 2013;108(5):679–92. - PubMed
    1. Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3–20. - PubMed
    1. Desai TK, Stecevic V, Chang CH, et al. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc. 2005;61(7):795–801. - PubMed
    1. Dellon ES. Epidemiology of eosinophilic esophagitis. Gastroenterology Clinics of North America. 2014;43:201–18. - PMC - PubMed
    1. Jensen ET, Kappelman MD, Martin CF, Dellon ES. Health-care utilization, costs, and the burden of disease related to eosinophilic esophagitis in the United States. Am J Gastroenterol. 2015;110(5):626–32. - PMC - PubMed