Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study
Por:
Molina-Infante, J, Arias, A, Alcedo, J, Garcia-Romero, R, Casabona-Frances, S, Prieto-Garcia, A, Modolell, I, Gonzalez-Cordero, PL, Perez-Martinez, I, Martin-Lorente, JL, Guarner-Argente, C, Masiques, ML, Vila-Miravet, V, Garcia-Puig, R, Savarino, E, Sanchez-Vegazo, CT, Santander, C, Lucendo, AJ
Publicada:
1 abr 2018
Resumen:
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. ATFGED 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.
Filiaciones:
Molina-Infante, J:
Hosp Univ San Pedro De Alcantara, Dept Gastroenterol, Avda Pablo Naranjo S-N, Caceres 10003, Spain
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Arias, A:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Gen Mancha Ctr, Res Unit, Ciudad Real, Spain
Alcedo, J:
Hosp Univ Miguel Servet, Dept Gastroenterol, Zaragoza, Spain
Garcia-Romero, R:
Hosp Univ Miguel Servet, Dept Pediat, Zaragoza, Spain
Casabona-Frances, S:
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa, Dept Gastroenterol, Madrid, Spain
Prieto-Garcia, A:
Hosp Gen Univ Gregorio Maranon, Dept Allergy, Madrid, Spain
Modolell, I:
Consorci Sanitari Terrassa, Dept Gastroenterol, Barcelona, Spain
Gonzalez-Cordero, PL:
Hosp Univ San Pedro De Alcantara, Dept Gastroenterol, Avda Pablo Naranjo S-N, Caceres 10003, Spain
Perez-Martinez, I:
Hosp Univ Cent Asturias, Dept Gastroenterol, Oviedo, Spain
Martin-Lorente, JL:
Hosp Univ Burgos, Dept Gastroenterol, Burgos, Spain
Guarner-Argente, C:
Hosp Santa Crue & St Pau, Dept Gastroenterol, Barcelona, Spain
Masiques, ML:
Hosp Gen Granollers, Dept Pediat, Barcelona, Spain
Vila-Miravet, V:
Hosp St Joan Deu, Dept Pediat, Barcelona, Spain
Garcia-Puig, R:
Hosp Univ Mutua Terrassa, Dept Pediat, Barcelona, Spain
Savarino, E:
Univ Padua, Div Gastroenterol, Dept Surg Oncol & Gastroenterol, Padua, Italy
Sanchez-Vegazo, CT:
Hosp Univ Ramon y Cajal, Dept Gastroenterol, Madrid, Spain
Santander, C:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Univ La Princesa, Inst Invest Sanitaria Princesa, Dept Gastroenterol, Madrid, Spain
Lucendo, AJ:
Ctr Invest Biomed Red Enfermedades Hepat & Digest, Madrid, Spain
Hosp Gen Tomelloso, Dept Gastroenterol, Vereda Socuellamos S-N, Tomelloso 13700, Spain
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