Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study.
Javier Molina-Infante,Ángel Arias,Javier Alcedo,Ruth Garcia-Romero,Sergio Casabona-Frances,Alicia Prieto-Garcia,Ines Modolell,Pedro L. Gonzalez-Cordero,Isabel Pérez-Martínez,Jose Luis Martin-Lorente,Carlos Guarner-Argente,Maria L. Masiques,Victor Vila-Miravet,Roger García-Puig,Edoardo Savarino,Carlos Teruel Sanchez-Vegazo,Cecilio Santander,Alfredo J. Lucendo +17 more
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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.Abstract:
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. A TFGED 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.read more
Citations
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Nutrition Interventions in Rheumatoid Arthritis: The Potential Use of Plant-Based Diets. A Review
Jihad Alwarith,Hana Kahleova,Emilie Rembert,Willy N. Yonas,Sara Dort,Manuel Calcagno,Nora N Burgess,Lee Crosby,Neal D. Barnard,Neal D. Barnard +9 more
TL;DR: A review examines the potential role of a plant-based diet in mediating RA symptoms and finds that a vegan diet helps improve symptoms by eliminating many of the trigger foods in RA patients, thus reducing their inflammation and joint pain.
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Efficacy of proton pump inhibitor therapy for eosinophilic oesophagitis in 630 patients: results from the EoE connect registry.
Emilio J Laserna-Mendieta,Sergio Casabona,Danila Guagnozzi,Edoardo Savarino,Antonia Perelló,Antonio Guardiola-Arévalo,Jesús Barrio,Isabel Pérez-Martínez,Anne Lund Krarup,Javier Alcedo,Susana de la Riva,Esther Rey-Iborra,Cecilio Santander,Ángel Arias,Alfredo J. Lucendo +14 more
TL;DR: Inflammatory EoE phenotype and treatment duration up to 12 weeks provided the greatest benefits for inducing remission of Eosinophilic oesophagitis and a stricturing phenotype decreased response rates to PPI therapy both initially and in the long term.
Journal ArticleDOI
Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis.
Ikuo Hirano,Glenn T. Furuta +1 more
TL;DR: A treat to target approach is proposed, based on symptoms and findings from endoscopy and histology, that addresses dissociations between outcomes such as symptom persistence despite normalization of histologic features and symptom resolution after esophageal dilation despite Histologic features of active disease.
Journal ArticleDOI
Efficacy of Therapy for Eosinophilic Esophagitis in Real-World Practice
Emilio J Laserna-Mendieta,Sergio Casabona,Edoardo Savarino,Antonia Perelló,Isabel Pérez-Martínez,Danila Guagnozzi,Jesús Barrio,Antonio Guardiola,Teresa Asensio,Susana de la Riva,Miriam Ruiz-Ponce,Juan Armando Rodriguez-Oballe,Cecilio Santander,Ángel Arias,Alfredo J. Lucendo +14 more
TL;DR: An analysis of data from a large cohort of patients with EoE in Europe found topical steroids to be the most effective at inducing clinical and histologic remission, but PPIs to beThe most frequently prescribed.
Journal ArticleDOI
Technical Review on the Management of Eosinophilic Esophagitis: A Report From the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters.
Matthew A. Rank,Rajiv N. Sharaf,Glenn T. Furuta,Seema S. Aceves,Matthew Greenhawt,Jonathan M. Spergel,Yngve T. Falck-Ytter,Evan S. Dellon,Karen A. Chachu,Lukejohn W. Day,Benjamin Lebwohl,Thiruvengadam Muniraj,Amit Patel,Anne F. Peery,Raj J. Shah,Harminder Singh,Siddharth Singh,Stuart J. Spechler,Shahnaz Sultan,Grace L. Su,Aaron P. Thrift,Jennifer M. Weiss,Adam V. Weizman,Jonathan A. Bernstein,Chitra Dinakar,David B.K. Golden,David A. Khan,Jay Lieberman,John Oppenheimer,Marcus Shaker,David R. Stukus,Dana V. Wallace,Julie Wang +32 more
TL;DR: An expert panel was convened by the American Gastroenterological Association Institute and the Joint Task Force on Allergy-Immunology Practice Parameters to provide a technical review to be used as the basis for an updated clinical guideline.
References
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Eosinophilic esophagitis: Updated consensus recommendations for children and adults
Chris A. Liacouras,Glenn T. Furuta,Ikuo Hirano,Dan Atkins,Stephen Attwood,Peter A Bonis,A. Wesley Burks,Mirna Chehade,Margaret H. Collins,Evan S. Dellon,Ranjan Dohil,Gary W. Falk,Nirmala Gonsalves,Sandeep K. Gupta,David A. Katzka,Alfredo J. Lucendo,Jonathan E. Markowitz,Richard J. Noel,Robert D. Odze,Philip E. Putnam,Joel E. Richter,Yvonne Romero,Eduardo Ruchelli,Hugh A. Sampson,Alain M. Schoepfer,Nicholas J. Shaheen,Scott H. Sicherer,Stuart J. Spechler,Jonathan M. Spergel,Alex Straumann,Barry K. Wershil,Marc E. Rothenberg,Seema S. Aceves +32 more
TL;DR: A new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation.
Journal ArticleDOI
Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula.
Kevin J. Kelly,Audrey J. Lazenby,Peter C. Rowe,John H. Yardley,Jay A. Perman,Hugh A. Sampson +5 more
TL;DR: Chronic gastrointestinal symptoms and histological changes of the esophagus unresponsive to standard treatments for gastroesophageal reflux were improved by the use of elemental formulas.
Journal ArticleDOI
Esophageal Eosinophilia with Dysphagia A Distinct Clinicopathologic Syndrome
TL;DR: The presence of high concentrations of IEE in esophageal biopsies from patients with dysphagia, normal endoscopy, and normal 24-hr esophagal pH monitoring represents a distinctive clinicopathologic syndrome not previously described.
Journal ArticleDOI
Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years
Alex Straumann,Hans-Peter Spichtin,Leticia Grize,Kathleen A. Bucher,Christoph Beglinger,Hans-Uwe Simon +5 more
TL;DR: Eosinophilic esophagitis, a primary and chronic disease restricted to the esophagus, leads to persistent dysphagia and structural esophageal alterations but does not impact the nutritional state.
Journal ArticleDOI
Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis.
Amir F. Kagalwalla,Timothy Sentongo,Sally Ritz,Therese Hess,Suzanne P. Nelson,Karan M. Emerick,Hector Melin-Aldana,B U K Li +7 more
TL;DR: SFED treatment was associated with clinical and histologic improvement in EE in an observational study and should be considered as an option in the initial management of children with EE.
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