Sunday, April 12, 2015
Eosinophilic Esophagitis: The Food-Antigen Connection
Dietary Elimination Therapy Is an Effective Option for Adults With Eosinophilic Esophagitis
Wolf WA, Jerath MR, Sperry SL, Shaheen NJ, Dellon ES
Clin Gastroenterol Hepatol. 2014;12:1272-1279
EoE has been categorized as a food allergy because of evidence of disease remission with dietary elimination. Although swallowed corticosteroids have been shown to be effective, disease relapse is likely upon discontinuance. Dietary elimination therapy may be more durable if specific food groups to withdraw can be identified.
Wolf and colleagues demonstrated that dietary modification is an effective nonpharmacologic intervention in patients with EoE. This was a retrospective cohort study from a database of adults with EoE diagnosed using consensus guidelines. These adults underwent dietary food group exclusion either by using targeted elimination identified through allergy skin prick testing or patient report or by following a six-food group elimination diet (SFED), which involved removal of dairy, wheat, soy, nuts, seafood, and eggs. Patients were taken off steroids for 4 weeks before beginning dietary therapy. If clinical improvement was observed with SFED, one food group was sequentially reintroduced every 6 weeks. Endoscopy with biopsies was performed until all food groups were reintroduced, and the foods that induced recrudescence of EoE were identified.
Symptom improvement, endoscopic appearance improvement, and biopsy resolution to less than 15 eosinophils/high-power field (eos/HPF) are shown in the Table.
In patients who responded with eosinophil counts lower than 15 eos/HPF and underwent food reintroduction, symptom recurrence was highest with dairy (44%) and eggs (44%), followed by wheat (22%) and shellfish, legumes, or nuts (11% each).