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.

中文翻译：

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小儿和成人嗜酸性粒细胞性食管炎的逐步经验消除饮食：2-4-6研究

背景

许多饮食限制和内镜检查限制了嗜酸性粒细胞性食管炎（EoE）患者的经验消除饮食的实施。牛奶和小麦/面筋是最常见的食物诱因。

客观的

我们试图评估针对EoE的逐步饮食策略的有效性。

方法

我们在14个中心进行了一项前瞻性研究。患者接受了为期6周的2种食物组消除饮食（TFGED；含牛奶和谷蛋白的谷物）。缓解的定义是症状改善和嗜酸性粒细胞/高倍视野少于15个。无反应者逐渐获得4种食物组消除饮食（FFGED; TFGED加上鸡蛋和豆类食物）和6种食物组消除饮食（SFGED; FFGED加上坚果和鱼/海鲜）。在有反应者中，被淘汰的食物被单独重新引入，然后进行内窥镜检查。

结果

招募了130位患者（25位儿科患者），其中97位完成了研究的所有阶段。TFGED在56位（43％）患者中实现了EoE缓解，年龄之间无差异。TFGED应答者中的食物触发因素是牛奶（52％），含麸质谷物（16％）和两者（28％）。仅牛奶引起的EoE分别存在于成人和儿童的18％和33％中。FFGED和SFGED的缓解率分别为60％和79％，其中食物触发因素的增加，特别是在SFGED后。总体而言，TFGED / FFGED应答者中有60名中有55名（91.6％）有1或2种食物触发因素。与最初的SFGED相比，升压策略将内窥镜检查程序和诊断过程时间减少了20％。

结论

TFGED饮食可使43％的儿童和成人实现EoE缓解。采取逐步采取的措施，可以尽早确定大多数经验型饮食的应答者，而很少触发食物，避免不必要的饮食限制，节省内镜检查，并缩短诊断过程。