Combined and Alternating Topical Steroids and Food Elimination Diet for the Treatment of Eosinophilic Esophagitis

被引:24
作者
Reed, Craig C. [1 ,2 ]
Safta, Anca M. [3 ]
Qasem, Shadi [4 ]
Almond, M. Angie [3 ]
Dellon, Evan S. [1 ,2 ]
Jensen, Elizabeth T. [1 ,2 ,5 ]
机构
[1] Univ N Carolina, Sch Med, Ctr Esophageal Dis & Swallowing, Div Gastroenterol & Hepatol,Dept Med, CB 7080,Rm 4140,Bioinformat Bldg, Chapel Hill, NC 27599 USA
[2] Univ N Carolina, Sch Med, Ctr Gastrointestinal Biol & Dis, Div Gastroenterol & Hepatol,Dept Med, CB 7080,Rm 4140,Bioinformat Bldg, Chapel Hill, NC 27599 USA
[3] Wake Forest Sch Med, Dept Pediat, Div Pediat Gastroenterol, Med Ctr Blvd, Winston Salem, NC 27157 USA
[4] Univ Kentucky, Sch Med, Dept Pathol & Lab Med, 800 Rose St,MS141, Lexington, KY 40536 USA
[5] Wake Forest Univ, Bowman Gray Sch Med, Dept Epidemiol & Prevent, Div Publ Hlth Sci, Med Ctr Blvd, Winston Salem, NC 27157 USA
关键词
Dysphagia; Food bolus impaction; Eosinophilic esophagitis; topical corticosteroids; FLUTICASONE PROPIONATE; CONSENSUS RECOMMENDATIONS; BUDESONIDE; MANAGEMENT; DIAGNOSIS; CHILDREN; THERAPY; ADULTS;
D O I
10.1007/s10620-018-4931-9
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background Few studies have examined combined or alternating treatment algorithms in eosinophilic esophagitis. Aims We conducted a retrospective cohort study to ascertain the efficacy and adherence to a combined and alternating treatment approach with topical corticosteroids and 2-food elimination diet for pediatric EoE. Methods Patients were prescribed a 2-food elimination diet (milk and soy) and topical corticosteroid (fluticasone or oral viscous budesonide) for 3 months, after which the steroid was discontinued and 2-food elimination diet continued for 3 months. An EGD was performed at baseline, 3 and 6 months. Clinical, endoscopic, and histologic data were extracted from electronic medical records. Nonparametric tests assessed adherence and outcomes. Results Twenty-nine eosinophilic esophagitis cases were included (mean age 11.5 years, 61% male). Complete adherence to combined therapy and 2-food elimination diet alone was 75 and 79%, respectively. Median eosinophil counts decreased from 51 to 2 eosinophils/hpf (p < 0.001) after combined treatment and rebounded to 31 (p = 0.07) after 2FED alone. Dysphagia improved after both the combined and 2-food elimination diet alone treatment approaches (52 vs. 11% and 10%; p = 0.001, 0.005). Nonsignificant improvements in endoscopic findings were documented across the length of follow-up. Conclusions An initial combined treatment approach resulted in significant improvements in symptoms and histologic findings. While symptomatic improvements continued with 2-food elimination diet alone, the histologic improvement was not maintained. While loss to follow-up may obscure the efficacy of 2-food elimination diet alone, a combined/alternating treatment approach merits assessment in a larger prospective study.
引用
收藏
页码:2381 / 2388
页数:8
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