Estudio prospectivo de los Cuatro Alimentos Dieta de Eliminación demuestra una eficacia comparable en el tratamiento de adultos y niños esofagitis eosinofílica

Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disorder triggered by food antigens. A six food elinination diet is effective in treating children and adults with EoE. The most common food triggers identified were milk, wheat, egg, and soy.

AIMS:

we assessed the effectiveness of four food elimination diet (FFED) eliminating milk, wheat, egg and soy in treating adults and children with EoE. Primary endpoint was improvement in hispathology and secondary endpoints were improvements in endoscopic features, symptoms, and quiality of life (QOL).

METHODS:

Prospective clinical trial of adults and children diagnosed with EoE based on current guidelines. Enrolled patients underwent esophagogastroduodenoscopies (EGD) with bipesies after 6 weeks od FFED. Symptom scores, QOL measures and endoscopic features (defined by EREFS score) were obtained before/after FFED. Histologic response was defined as complete (≤ 5eos/hpf), near compete (\leq10eos/apf) and partial (≥ 50% reduction in baseline eos). Responders underwent sequential food reintroduction followed by EGD with biopsy.

RESULTS:

13 adults (61, 5% male, median age 31) and 15 children (66, 7% male, median age 9) completed FFED to date. 5 adults and 12 children have begun reintroduction phase. Dysphagia (100%), food impaction (69%) and heartburn (38%) were common symptoms in adults. The mean peak eosinphil counts in adults before/after FFED were 52 an 13 eos/hpf (P<0.001) in the proximal esophagus and 53 and 20 eos/hpf (P<0.006) in the distal esophagus. After the FFED, 46% of patients had peak counts ≤ 5eos/hpf and 46% had peak counts of ≤ 10 eos/hpf- 85% had ≥ 50% reduction in peak eos. Endoscopic features improved in 70% and normalized in 8% of patients. Features improved were exudates (38%) rings (13%), edema (46%, P<0.01), furrows (46% P<0.05), and stricture diameter (62%) Symptom scores decreased in 81% (P<0.001). QOL scores were unchanged. In children, vomitimg (40%) abdominal pain (33%) and dysphagia (20%) were common. The mean peak eosinophil counts before/after FFED were 68 and 6 eos/hpf (P<0.001) in the proximal esophagus and 61 and 4 eos/hpf (P<0.001) in the distal esophagus. After FFED, 47% of patients had peak counts ≤ 5 eos/hpf and 60% had peak counts of ≤ 10 eos/hpf. 87% had ≥ 50% reduction in eos. Endoscopic features improved in 93% and normalized in 20% of patients. Features improved were exudates (89%, P<0.004) rings (100%), edema (50% p<0.003), and furrows (36%, p<0.004). Symotom scores decreased in 40%.

CONCLUSIONS:

1 FFED significantly improves histology, symptoms and endoscopic features in adults and children with EoE. 2) The changes demonstrated in both adult and pediatric cohorts were similar. 3) FFED is a feasible alternative to six food elimination diet, reducing overall time to complete therapy and improving patient acceptance of dietary limitations