Efficacy of <scp>I</scp>g<scp>E</scp>‐targeted <i>vs</i> empiric six‐food elimination diets for adult eosinophilic oesophagitis

Rodríguez-Sánchez, Joaquín; Torrijos, Elisa Gómez; Viedma, Bartolomé López; Belda, E De La Santa; Dávila, Francisco Martín; Rodriguez, Carmen García; Brito, Francisco Feo; Camacho, J Olmedo; Figueroa, Pedro Reales; Molina–Infante, Javier

doi:10.1111/all.12420

Cited by 72 publications

(60 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…SFED diets have also proven to be more effective than allergy testing directed therapy in a small retrospective cohort of 31 patients at UNC-Chapel Hill. SFED showed greater symptom improvement rate (78% vs. 68%) histological response rate (75% vs. 50%) and histological remission rate (56% vs. 32%) [87]. This data was also supported in a meta-analysis, by Arias, in which SFED (72.1%) was significantly better than Targeted Diet (45.5%).…”

Section: Empiric Elimination Dietsupporting

confidence: 56%

“…Studies have shown that loss of tolerance of foods such as milk or nuts can occur when food is removed [87]. Therefore, patients with significant food specific IgE serum levels or positive skin prick testing should, according to the guidelines from Journal of Allergy and Clinical Immunology in 2011, be supplied with an injectable epinephrine to guard against anaphylaxis [17].…”

Section: Empiric Elimination Dietmentioning

confidence: 99%

See 1 more Smart Citation

Eosinophilic Esophagitis: A Comprehensive Review

Nt¹

2016

J Hepatol Gastroint Dis

View full text Add to dashboard Cite

Eosinophilic Esophagitis (EoE) has been the subject of intense research and study over the past few years, as incidence and prevalence has increased in the United States, especially in adults. The signs, symptoms and complications of EoE arise from a complex interplay of genetic predisposition and environmental exposure that is not understood well at this time. The disease causes significant morbidity in both physical and psychological areas, and these effects may become permanent in some cases where remodeling of the epithelium is present. Treatment at this time mainly focuses on diet, medication and endoscopic dilation. While none of these entities can accomplish all of the treatment goals, careful selection of patients based on symptoms and physical findings can alleviate many of the complications of the disease. In addition, this review attempts to cull data from adult studies if possible, as much of the studies that involved children did not translate well to adult patients.

show abstract

Section: Empiric Elimination Dietsupporting

confidence: 56%

Section: Empiric Elimination Dietmentioning

confidence: 99%

Eosinophilic Esophagitis: A Comprehensive Review

Nt¹

2016

J Hepatol Gastroint Dis

View full text Add to dashboard Cite

show abstract

“…That said, in recent years, EoE remission rates of over 70% have been reported for adults treated with an empiric 6-food elimination diet [24] and diets based on allergy tests [25]. The allergic mechanism of EoE involves both IgE and non-IgE processes [26], possibly explaining why treatment with diets based on immediate hypersensitivity test results fails in approximately 30% of cases.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis: Demographic, Clinical, Endoscopic, Histologic, and Atopic Characteristics of Children and Teenagers in a Region in Central Spain

Torrijos

Miranda

Palencia

et al. 2017

J Investig Allergol Clin Immunol

View full text Add to dashboard Cite

Background and objective: Eosinophilic esophagitis (EoE) is an increasingly prevalent chronic inflammatory disease of the esophagus with an immunoallergic etiology. Few studies have been published on EoE in children and adolescents. The objective of this study was to analyze the demographic, clinical, serologic, endoscopic-histologic, and atopic characteristics of pediatric patients with EoE and to identify atopic and digestive comorbidities. Methods: We conducted a prospective observational study in children and adolescents (<16 years) assessed in a specialized multidisciplinary EoE unit in a tertiary referral hospital in a central region of Spain between 2011 and 2015. Results: Thirty-five patients were included in the study. Twenty-eight (80%) were male. The mean age was 9.6 years, 83% were atopic, and 28% reported a family history of atopy. The most common symptom was dysphagia (51%). Eosinophilia was detected in the blood of 60% of patients. Eosinophil cationic protein and total IgE were elevated in 88% and 77% of patients, respectively. The most frequent endoscopic finding was linear grooves (57%). Skin tests with aeroallergens were positive in 82% of patients (pollen 62% and food 60%). The main atopic comorbidities were asthma (48%) and rhinoconjunctivitis (37%). Digestive diseases were more often associated with gastritis and Helicobacter pylori infection (17%). Conclusions: Our results are similar to those previously reported. EoE is more common in boys and in individuals with a history of atopy and sensitization to airborne allergens and food. These results support the consideration of EoE as an atopic disease and underline the important role of allergists in early diagnosis and treatment.

show abstract

“…Among studies that examined the effectiveness of monoclonal antibody treatment in EoE subjects, 80% defined histological remission as peak esophageal eosinophil counts within the range of 0 to ≤5 24, 25, 26, 27, 28. Approximately 26% (N = 15) of the eligible studies examined remission among EoE patients who received only the diet elimination treatment formula (SFED, FFGED, ELED) compared to other forms of treatment, with the most common definitions falling within 0 to ≤5 eosinophils/hpf 29, 30, 31, 32, 33, 34 or 11 to ≤15 eosinophils/hpf 35, 36, 37, 38, 39, 40. Interestingly, even among the SFED studies (N = 9), five studies defined remission within the range of 0 to ≤5 eosinophils/hpf, 29, 30, 31, 32, 34 and two studies considered histological remission as <15 eosinophils/hpf 38, 41…”

Section: Resultsmentioning

confidence: 99%

“…Of the 22 studies selected from European centers, 12 studies (55%) considered values within the range 11 to ≤15 eosinophils/hpf 17, 36, 37, 38, 39, 46, 47, 53, 54, 55, 56, 57, 58 as histological remission, and 4 studies (23%) defined histological remission as less than 5 or ≤ 5 eosinophils/hpf 30, 33, 42, 45. Strikingly, all studies conducted in Switzerland used a more stringent and consistent end‐point of <5 eosinophils /hpf to identify cases of histological remission 28, 59, 60…”

Section: Resultsmentioning

confidence: 99%

Systematic review of histological remission criteria in eosinophilic esophagitis

Eke

White

et al. 2018

JGH Open

View full text Add to dashboard Cite

Elemental diets, dietary elimination, and steroid therapies are the most common therapies in the clinical trials for eosinophilic esophagitis (EoE). Histological findings (usually reported as eosinophils per microscopic high‐powered field [hpf]) remain the most common end‐point used to define response. Yet, the threshold for defining “response” and “remission” are ill‐defined among consensus guidelines and may vary from study to study. We conducted a systematic literature review of articles on eosinophilic esophagitis, published between January 2007 and November 2017, considering histological remission as the primary outcome. We abstracted treatment information and definitions of histological remission or response. A comparison of definitions of histological remission across and within institutions was performed. A total of 61 articles were included in this review, with approximately 60% of the studies published from centers in the United States. Histological definitions of remission of EoE ranged from 0 to ≤20 eosinophils/hpf. The most stringent criteria, ranging from 0 to ≤5 eosinophils/hpf, were commonly used in interventional trial studies that examined the effects of new treatments. We found remarkable variability in definitions between studies, treatment types, and regions. Age or epidemiological distribution of study subjects did not influence the criteria for histological remission. Clinical and histological improvements are important measures of the effects of treatment. Histological findings, the most objective measure of treatment, should provide an optimal method for comparing the effectiveness of various treatments. Yet, our findings suggest a lack of consistent remission criteria in published studies. Considering these inconsistencies, it is difficult to compare the effectiveness of various treatments.

show abstract

Efficacy of IgE‐targeted vs empiric six‐food elimination diets for adult eosinophilic oesophagitis

Abstract: Histological remission was accomplished in 73% of patients undergoing sIgE-ED, which was nonsignificantly superior to SFED. sIgE effectively identified cow's milk as a food trigger in IgE-sensitized patients.

Cited by 72 publications

References 33 publications

Eosinophilic Esophagitis: A Comprehensive Review

Eosinophilic Esophagitis: A Comprehensive Review

Eosinophilic Esophagitis: Demographic, Clinical, Endoscopic, Histologic, and Atopic Characteristics of Children and Teenagers in a Region in Central Spain

Systematic review of histological remission criteria in eosinophilic esophagitis

Contact Info

Product

Resources

About