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Comparative Study
. 2018 Sep;63(9):2381-2388.
doi: 10.1007/s10620-018-4931-9. Epub 2018 Jan 29.

Combined and Alternating Topical Steroids and Food Elimination Diet for the Treatment of Eosinophilic Esophagitis

Craig C Reed  1 , Anca M Safta  2 , Shadi Qasem  3 , M Angie Almond  2 , Evan S Dellon  1 , Elizabeth T Jensen  4   5
Affiliations
Comparative Study

Combined and Alternating Topical Steroids and Food Elimination Diet for the Treatment of Eosinophilic Esophagitis

Craig C Reed et al. Dig Dis Sci. 2018 Sep.

Abstract

Background: Few studies have examined combined or alternating treatment algorithms in eosinophilic esophagitis.

Aims: We conducted a retrospective cohort study to ascertain the efficacy and adherence to a combined and alternating treatment approach with topical corticosteroids and 2-food elimination diet for pediatric EoE.

Methods: Patients were prescribed a 2-food elimination diet (milk and soy) and topical corticosteroid (fluticasone or oral viscous budesonide) for 3 months, after which the steroid was discontinued and 2-food elimination diet continued for 3 months. An EGD was performed at baseline, 3 and 6 months. Clinical, endoscopic, and histologic data were extracted from electronic medical records. Nonparametric tests assessed adherence and outcomes.

Results: Twenty-nine eosinophilic esophagitis cases were included (mean age 11.5 years, 61% male). Complete adherence to combined therapy and 2-food elimination diet alone was 75 and 79%, respectively. Median eosinophil counts decreased from 51 to 2 eosinophils/hpf (p < 0.001) after combined treatment and rebounded to 31 (p = 0.07) after 2FED alone. Dysphagia improved after both the combined and 2-food elimination diet alone treatment approaches (52 vs. 11% and 10%; p = 0.001, 0.005). Nonsignificant improvements in endoscopic findings were documented across the length of follow-up.

Conclusions: An initial combined treatment approach resulted in significant improvements in symptoms and histologic findings. While symptomatic improvements continued with 2-food elimination diet alone, the histologic improvement was not maintained. While loss to follow-up may obscure the efficacy of 2-food elimination diet alone, a combined/alternating treatment approach merits assessment in a larger prospective study.

Keywords: Dysphagia; Eosinophilic esophagitis, topical corticosteroids; Food bolus impaction.

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Conflict of interest statement

Potential competing interests: None of the authors report and potential conflicts of interest with this study. Dr. Dellon is a consultant for Adare, Alivio, Allakos, Banner, Enumeral, GSK, Receptos/Celegene, Regeneron, Roche, and Shire, receives research funding from Adare, Meritage, Miraca, Nutricia, Receptos/Celgene, Regeneron, and Shire, and has received an educational grant from Banner.

Figures

Figure 1.
Figure 1.
Patient flow throughout the treatment period for patients treated with topical corticosteroids (tCS) and 2-food elimination diet (2FED). At each point in the figure, the number of patients indicates those who remained on the treatment protocol and for which data were available for analysis.
Figure 2.
Figure 2.
(A) Symptom reporting across the study period for patients treated with topical corticosteroids (tCS) and 2-food elimination diet (2FED). (B) Endoscopic findings across the study period for patients treated with topical corticosteroids (tCS) and 2-food elimination diet (2FED).
Figure 2.
Figure 2.
(A) Symptom reporting across the study period for patients treated with topical corticosteroids (tCS) and 2-food elimination diet (2FED). (B) Endoscopic findings across the study period for patients treated with topical corticosteroids (tCS) and 2-food elimination diet (2FED).
Figure 3.
Figure 3.
Histologic findings across the study period for patients treated with after topical corticosteroids (tCS) and 2-food elimination diet (2FED).
See this image and copyright information in PMC

Comment in

References

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