Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis

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• 作者：Carol J. Henderson ; PhD ; RD^a ; J. Pablo Abonia ; MD^a ; Eileen C. King ; PhD^b ; Philip E. Putnam ; MD ; FAAP^c ; Margaret H. Collins ; MD^d ; James P. Franciosi ; MD ; MS ; MSCE^c ; Marc E. Rothenberg ; MD ; PhD^a ; ^{Rothenberg@cchmc.org}
• 关键词：Eosinophilic esophagitis ; eosinophils ; histologic remission ; pediatric ; dietary therapy ; food allergy ; negative predictive values ; elemental diet ; 6-food elimination diet ; skin test&ndash ; directed elimination diet
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2012
• 期刊代码：158_00916749
• 类别：med
• 出版时间：June, 2012
• 卷：129
• 期：6
• 页码：1570-1578
• 文件大小：337 K

摘要

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Background

Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies are limited.

Objective

This study compared the effectiveness of 3 frequently prescribed dietary therapies (elemental, 6-food elimination, and skin prick and atopy patch-directed elimination diets) and assessed the remission predictability of skin tests and their utility in directing dietary planning.

Methods

A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated patients with eosinophilic esophagitis who had 2 consecutive endoscopic biopsy specimens associated with dietary intervention was identified. Biopsy histology and remissions (<15 eosinophils/high-power field) after dietary therapy and food reintroductions were evaluated.

Results

Ninety-eight of 513 patients met the eligibility criteria. Of these 98 patients, 50%(n聽= 49), 27%(n聽= 26), and 23%(n聽= 23) received elemental, 6-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65%of patients on elemental, 6-food elimination, and directed diets, respectively. The odds of postdiet remission versus nonremission were 5.6-fold higher (P聽= .05) on elemental versus 6-food elimination diets and 12.5-fold higher (P聽= .003) on elemental versus directed diets and were not significantly different (P聽=聽.22) on 6-food elimination versus directed diets. After 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40%to 67%(milk, 40%; egg, 56%; soy, 64%; and wheat, 67%).

Conclusion

All 3 dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with 6-food elimination and skin test-directed diets. Notably, an empiric 6-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin test results.