Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611-2951, USA.
Gastroenterology. 2012 Jun;142(7):1451-9.e1; quiz e14-5. doi: 10.1053/j.gastro.2012.03.001. Epub 2012 Mar 3.
BACKGROUND & AIMS: Adults with eosinophilic esophagitis (EoE) typically present with dysphagia and food impaction. A 6-food elimination diet (SFED) is effective in children with EoE. We assessed the effects of the SFED followed by food reintroduction on the histologic response, symptoms, and quality of life in adults with EoE.
At the start of the study, 50 adults with EoE underwent esophagogastroduodenoscopies (EGDs), biopsies, and skin-prick tests for food and aeroallergens. After 6 weeks of SFED, patients underwent repeat EGD and biopsies. Histologic responders, defined by ≤ 5 eosinophils/high-power field (eos/hpf) (n = 32), underwent systematic reintroduction of foods followed by EGD and biopsies (n = 20). Symptom and quality of life scores were determined before and after SFED.
Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%). The mean peak eosinophil counts in the proximal esophagus were 34 eos/hpf and 8 eos/hpf, before and after the SFED, and 44 eos/hpf and 13 eos/hpf in the distal esophagus, respectively (P < .0001). After the SFED, 64% of patients had peak counts ≤ 5 eos/hpf and 70% had peak counts of ≤ 10 eos/hpf. Symptom scores decreased in 94% (P < .0001). After food reintroduction, esophageal eosinophil counts returned to pretreatment values (P < .0001). Based on reintroduction, the foods most frequently associated with EoE were wheat (60% of cases) and milk (50% of cases). Skin-prick testing predicted only 13% of foods associated with EoE.
An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults. Food reintroduction re-initiated features of EoE in patients, indicating a role for food allergens in its pathogenesis. Foods that activated EoE were identified by systematic reintroduction analysis but not by skin-prick tests.
成人嗜酸细胞性食管炎（EoE）通常表现为吞咽困难和食物嵌塞。六食物剔除饮食（SFED）对 EoE 患儿有效。我们评估了 SFED 继以食物再引入对 EoE 成人的组织学反应、症状和生活质量的影响。
在研究开始时，50 名 EoE 成人接受了食管胃十二指肠镜检查（EGD）、活检和食物及变应原皮肤点刺试验。SFED 后 6 周，患者再次接受 EGD 和活检。组织学应答者（定义为≤5 个高倍视野（eos/hpf）中的嗜酸性粒细胞（ eos/hpf）（n=32））接受系统的食物再引入，然后再次进行 EGD 和活检（n=20）。在 SFED 前后测定症状和生活质量评分。
EoE 的常见症状包括吞咽困难（96%）、食物嵌塞（74%）和烧心（94%）。近端食管的平均嗜酸性粒细胞计数分别为 SFED 前 34 eos/hpf 和 SFED 后 8 eos/hpf，远端食管分别为 44 eos/hpf 和 13 eos/hpf（P<.0001）。SFED 后，64%的患者峰值计数≤5 eos/hpf，70%的患者峰值计数≤10 eos/hpf。94%的患者症状评分下降（P<.0001）。食物再引入后，食管嗜酸性粒细胞计数恢复到治疗前水平（P<.0001）。根据再引入结果，与 EoE 最相关的食物是小麦（60%的病例）和牛奶（50%的病例）。皮肤点刺试验仅预测了 13%的与 EoE 相关的食物。
剔除饮食显著改善了成人 EoE 的症状，并降低了内镜和组织病理学特征。食物再引入使患者的 EoE 特征重新出现，表明食物过敏原在其发病机制中起作用。通过系统的再引入分析而非皮肤点刺试验确定了激活 EoE 的食物。
