Step-Up Empiric Elimination Diet for Pediatric and Adult Eosinophilic Esophagitis: The 2-4-6 Study
| Autor: | Jose Luis Martin-Lorente, Cecilio Santander, Pedro L. Gonzalez-Cordero, Maria L. Masiques, Isabel Pérez-Martínez, Alicia Prieto-Garcia, Ángel Arias, Sergio Casabona-Frances, Edoardo Savarino, Victor Vila-Miravet, Carlos Guarner-Argente, Ruth Garcia-Romero, Ines Modolell, Javier Molina-Infante, Alfredo J. Lucendo, Javier Alcedo, Carlos Teruel Sanchez-Vegazo, Roger García-Puig |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Gastroenterology Food group 0302 clinical medicine Risk Factors Interquartile range wheat Immunology and Allergy diet Prospective Studies Prospective cohort study 030223 otorhinolaryngology chemistry.chemical_classification milk Eosinophilic esophagitis Diet Milk Six-food elimination Wheat Immunology Treatment Outcome 030220 oncology & carcinogenesis six-food elimination Female 030211 gastroenterology & hepatology Food Hypersensitivity Adult medicine.medical_specialty medicine.drug_class Proton-pump inhibitor 03 medical and health sciences Internal medicine Elimination diet medicine Humans In patient Hepatology business.industry medicine.disease Gluten Surgery chemistry business |
| Zdroj: | JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau instname r-FSJD. Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu r-FSJD: Repositorio Institucional de Producción Científica de la Fundació Sant Joan de Déu Fundació Sant Joan de Déu |
| ISSN: | 0016-5085 0091-6749 |
| DOI: | 10.1016/s0016-5085(17)30998-8 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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