Original ResearchClinical—Alimentary TractElimination Diet Effectively Treats Eosinophilic Esophagitis in Adults; Food Reintroduction Identifies Causative Factors
Section snippets
Study Design
This was a prospective clinical trial from 2006 to 2010 performed at a single university medical center. The study was designed to examine the effectiveness of SFED in adults with EoE. All patients underwent an elimination diet for 6 weeks followed by esophagogastroduodenoscopy (EGD) and biopsy. Patients who achieved histologic remission underwent systematic, sequential food reintroduction with follow-up endoscopies and biopsies to identify specific food triggers.
Study End Points
The primary study end point was
Patient Characteristics and Clinical Features
Fifty patients (25 men) completed the initial 6-week SFED treatment period, and 20 patients completed the reintroduction process. Demographics are listed in Table 1. Thirty patients were not included in the analysis of the reintroduction process because of a lack of adequate response or incomplete data acquisition for the following reasons: nonresponse (8), partial response (7), moved out of state (3), and still completing the reintroduction process (12). Forty-two of 50 patients were on
Discussion
Our prospective study showed a high degree of effectiveness of the SFED in the treatment of both symptoms and histopathology in adults with EoE.20 Seventy-eight percent of patients achieved greater than a 50% reduction in peak eosinophil counts, with 70% achieving ≤10 eos/hpf and 64% achieving ≤5 eos/hpf after treatment. Coinciding with resolution in pathology, dysphagia symptom scores improved significantly after the SFED. The systematic reintroduction of food in patients who achieved an
Acknowledgments
The authors thank Northwestern EoE patients and families for their research participation, the academic and contributed services gastroenterology faculty and fellows at Northwestern for assistance with patient recruitment; Ms Chrissy Ebert–Nelson for coordination of IRB documentation; Dr Laurie Keefer for assistance with interpretation of quality of life data; and Dr Mary Kwasny for statistical support.
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This article has an accompanying continuing medical education activity on page e14. Learning Objectives: Upon completion of this assessment, successful learners will be able to understand the evidence supporting the use of dietary therapy in adult eosinophilic esophagitis.
Conflicts of interest The authors disclose no conflicts.