Browse > Article
http://dx.doi.org/10.5223/pghn.2020.23.1.79

Efficacy of Dairy Free Diet and 6-Food Elimination Diet as Initial Therapy for Pediatric Eosinophilic Esophagitis: A Retrospective Single-Center Study  

Wong, Jonathan (Department of Pediatrics, University of Connecticut School of Medicine)
Goodine, Sue (Department of Pediatrics, Division of Digestive Diseases, Hepatology and Nutrition, Connecticut Children's Medical Center)
Samela, Kate (Department of Pediatrics, Division of Digestive Diseases, Hepatology and Nutrition, Connecticut Children's Medical Center)
Vance, Katherine S. (Department of Pediatrics, Division of Digestive Diseases, Hepatology and Nutrition, Connecticut Children's Medical Center)
Chatfield, Beth (Department of Pediatrics, Division of Digestive Diseases, Hepatology and Nutrition, Connecticut Children's Medical Center)
Wang, Zhu (Department of Pediatrics, University of Connecticut School of Medicine)
Sayej, Wael N. (Department of Pediatrics, University of Connecticut School of Medicine)
Publication Information
Pediatric Gastroenterology, Hepatology & Nutrition / v.23, no.1, 2020 , pp. 79-88 More about this Journal
Abstract
Purpose: Management of eosinophilic esophagitis (EoE) varies from center to center. In this study, we evaluated the effectiveness of a dairy-free diet (DFD) and the 6-Food Elimination Diet (SFED) as initial therapies for the treatment of EoE in our practice. Methods: This was a retrospective study of children who had been treated for EoE at Connecticut Children's Medical Center, Hartford, CT, USA. Pre- and post-treatment endoscopy findings and histology results of patients treated with DFD or SFED were examined. Results: One hundred fifty-two patients (age 9.2±5.2 years, 76.3% male, 69.7% caucasian) met the inclusion criteria for initial treatment with DFD (n=102) or SFED (n=50). Response for DFD was 56.9% and for SFED was 52.0%. Response based on treatment duration (<10, 10-12, and >12 weeks) were 81.8%, 50.0%, and 55.1% for DFD, and 68.8%, 50.0%, and 40.0% for SFED. Response based on age (<6, 6-12, and >12 years) were 59.3%, 42.9%, and 67.5% for DFD, and 36.4%, 58.8%, and 72.7% for SFED. In patients treated with DFD, concomitant proton pump inhibitor (PPI) administration resulted in improved outcomes (p=0.0177). Bivariate regression analysis showed that PPI with diet is the only predictor of response (p=0.0491), however, there were no significant predictors on multiple regression analysis. Conclusion: DFD and SFED are effective first line therapies for EoE. DFD should be tried first before extensive elimination diets. Concomitant therapy with PPI's may be helpful.
Keywords
Eosinophilic esophagitis; Restriction diet therapy; Proton pump inhibitors;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Konikoff MR, Noel RJ, Blanchard C, Kirby C, Jameson SC, Buckmeier BK, et al. A randomized, double-blind, placebo-controlled trial of fluticasone propionate for pediatric eosinophilic esophagitis. Gastroenterology 2006;131:1381-91.   DOI
2 Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA. Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol 2003;98:777-82.   DOI
3 Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras CA. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 2005;95:336-43.   DOI
4 Molina-Infante J, Arias A, Alcedo J, Garcia-Romero R, Casabona-Frances S, Prieto-Garcia A, et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2-4-6 study. J Allergy Clin Immunol 2018;141:1365-72.   DOI
5 Kagalwalla AF, Wechsler JB, Amsden K, Schwartz S, Makhija M, Olive A, et al. Efficacy of a 4-food elimination diet for children with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2017;15:1698-707.e7.   DOI
6 Wechsler JB, Schwartz S, Amsden K, Kagalwalla AF. Elimination diets in the management of eosinophilic esophagitis. J Asthma Allergy 2014;7:85-94.   DOI
7 Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006;4:1097-102.   DOI
8 Kagalwalla AF, Amsden K, Shah A, Ritz S, Manuel-Rubio M, Dunne K, et al. Cow's milk elimination: a novel dietary approach to treat eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2012;55:711-6.   DOI
9 Kagalwalla AF, Shah A, Li BU, Sentongo TA, Ritz S, Manuel-Rubio M, et al. Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet. J Pediatr Gastroenterol Nutr 2011;53:145-9.   DOI
10 Kagalwalla AF, Shah A, Ritz S, Melin-Aldana H, Li BU. Cow's milk protein-induced eosinophilic esophagitis in a child with gluten-sensitive enteropathy. J Pediatr Gastroenterol Nutr 2007;44:386-8.   DOI
11 Asher Wolf W, Huang KZ, Durban R, Iqbal ZJ, Robey BS, Khalid FJ, et al. The six-food elimination diet for eosinophilic esophagitis increases grocery shopping cost and complexity. Dysphagia 2016;31:765-70.   DOI
12 Cotton CC, Eluri S, Wolf WA, Dellon ES. Six-food elimination diet and topical steroids are effective for eosinophilic esophagitis: a meta-regression. Dig Dis Sci 2017;62:2408-20.   DOI
13 Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al.; First International Gastrointestinal Eosinophil Research Symposium (FIGERS) Subcommittees. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342-63.   DOI
14 Zhang X, Cheng E, Huo X, Yu C, Zhang Q, Pham TH, et al. Omeprazole blocks STAT6 binding to the eotaxin-3 promoter in eosinophilic esophagitis cells. PLoS One 2012;7:e50037.   DOI
15 Aceves SS. Food and aeroallergens in eosinophilic esophagitis: role of the allergist in patient management. Curr Opin Gastroenterol 2014;30:391-5.   DOI
16 Cheng E, Zhang X, Huo X, Yu C, Zhang Q, Wang DH, et al. Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD. Gut 2013;62:824-32.   DOI
17 Benninger MS, Strohl M, Holy CE, Hanick AL, Bryson PC. Prevalence of atopic disease in patients with eosinophilic esophagitis. Int Forum Allergy Rhinol 2017;7:757-62.   DOI
18 Aceves SS. Food allergy testing in eosinophilic esophagitis: what the gastroenterologist needs to know. Clin Gastroenterol Hepatol 2014;12:1216-23.   DOI
19 Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995;109:1503-12.   DOI
20 Attwood SE, Smyrk TC, Demeester TR, Jones JB. Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993;38:109-16.   DOI
21 Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20.e6; quiz 21-2.   DOI
22 Molina-Infante J, Hernandez-Alonso M, Vinagre-Rodriguez G, Martin-Noguerol E. Proton pump inhibitors therapy for esophageal eosinophilia: simply following consensus guidelines. J Gastroenterol 2011;46:712-3; author reply 714-5.   DOI
23 Furuta GT. Eosinophilic esophagitis: update on clinicopathological manifestations and pathophysiology. Curr Opin Gastroenterol 2011;27:383-8.   DOI
24 Sayej WN, Patel R, Baker RD, Tron E, Baker SS. Treatment with high-dose proton pump inhibitors helps distinguish eosinophilic esophagitis from noneosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2009;49:393-9.   DOI
25 Dranove JE, Horn DS, Davis MA, Kernek KM, Gupta SK. Predictors of response to proton pump inhibitor therapy among children with significant esophageal eosinophilia. J Pediatr 2009;154:96-100.   DOI
26 Aceves SS, Dohil R, Newbury RO, Bastian JF. Topical viscous budesonide suspension for treatment of eosinophilic esophagitis. J Allergy Clin Immunol 2005;116:705-6.   DOI
27 Dohil R, Newbury R, Fox L, Bastian J, Aceves S. Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Gastroenterology 2010;139:418-29.   DOI
28 Fable JM, Fernandez M, Goodine S, Lerer T, Sayej WN. Retrospective comparison of fluticasone propionate and oral viscous budesonide in children with eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2018;66:26-32.   DOI
29 Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 2002;122:1216-25.   DOI