Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study.
J Allergy Clin Immunol
; 141(4): 1365-1372, 2018 04.
Article
em En
| MEDLINE
| ID: mdl-29074457
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.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Esofagite Eosinofílica
/
Hipersensibilidade Alimentar
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article