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Dietary elimination therapy improved symptoms of eosinophilic esophagitis
Dietary elimination therapy effectively reduced symptoms of eosinophilic esophagitis and improved endoscopic appearance in adult patients in a recent study.
“We've known for a while that dietary therapy works for children with eosinophilic esophagitis (EOE),” W. Asher Wolf, MD, MPH, division of gastroenterology and hepatology, University of North Carolina School of Medicine, told Healio.com/Gastroenterology. “We are very happy to find that dietary therapy is also effective in adults.”
W. Asher Wolf
Wolf and colleagues performed a retrospective cohort analysis of data collected from 2006 to 2012 to determine if dietary elimination therapy effectively treated EoE patients. Clinical and histologic improvement and predictors of treatment response were assessed in 31 adults (mean age, 36 years; 52% women; 90% Caucasian) who underwent a targeted elimination diet (TED; n=22) or a six-food elimination diet (SFED; n=9) for 6 weeks, commencing after at least 4 weeks without steroid therapy.
“In the past, research using diet to treat EoE focused on two diets (SFED and elemental diet), both of which were pretty challenging for patients,” Wolf said. “Our research looked at the SFED and found good results, and we also looked at TED where patients undergo allergy testing and avoid any foods to which they are allergic or to which they have reacted in the past. We found the TED worked as well as the SFED. While it still requires a lot of commitment, the TED seems more patient-friendly.”
Symptoms improved in 71% of participants overall, 68% of the TED and 78% of the SFED groups. Improved endoscopic appearance was observed in 54% of participants overall, including 53% and 56% of the TED and SFED groups, respectively. After treatment, overall eosinophil count per high-power field (eos/hpf) decreased from a baseline mean of 78 eos/hpf to 43 eos/hpf (P=.004). Overall, 39% of participants’ counts decreased to less than the disease diagnosis threshold of 15 eos/hpf (32% TED vs. 56% SFED; P=.41). Of nine patients who underwent reintroduction of foods to identify allergies, eggs and dairy were the most common, each affecting 44%. Clinical, endoscopic or histologic variables did not predict response to treatment, and of 26 participants who received topical corticosteroids at a different times, response rates were statistically similar to dietary therapy.
“Until recently, the utility of dietary elimination was unknown in adults,” according to an American Gastroenterological Association press release. “However, evidence is mounting; a June 2014 Gastroenterology meta-analysis reported that dietary interventions are effective in producing histologic remission in both pediatric and adult patients with EoE.”
“We don’t have any perfect therapies for EoE, but we have two good therapies: swallowed topical steroids and diet modification,” Wolf said. “It comes down to patient choice; there are patients who really want the simplicity of a daily drug, and there are patients who really want to avoid taking medicine. It is great to be able to offer patients a choice, and I think getting them engaged in making that choice leads to better outcomes.”
Disclosure: The researchers report no relevant financial disclosures.