比较饮食疗法在缓解小儿嗜酸性食管炎中的疗效。
Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis.
机构信息
Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
出版信息
J Allergy Clin Immunol. 2012 Jun;129(6):1570-8. doi: 10.1016/j.jaci.2012.03.023. Epub 2012 Apr 26.
BACKGROUND
Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies are limited.
OBJECTIVE
This study compared the effectiveness of 3 frequently prescribed dietary therapies (elemental, 6-food elimination, and skin prick and atopy patch-directed elimination diets) and assessed the remission predictability of skin tests and their utility in directing dietary planning.
METHODS
A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated patients with eosinophilic esophagitis who had 2 consecutive endoscopic biopsy specimens associated with dietary intervention was identified. Biopsy histology and remissions (<15 eosinophils/high-power field) after dietary therapy and food reintroductions were evaluated.
RESULTS
Ninety-eight of 513 patients met the eligibility criteria. Of these 98 patients, 50% (n= 49), 27% (n= 26), and 23% (n= 23) received elemental, 6-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, 6-food elimination, and directed diets, respectively. The odds of postdiet remission versus nonremission were 5.6-fold higher (P= .05) on elemental versus 6-food elimination diets and 12.5-fold higher (P= .003) on elemental versus directed diets and were not significantly different (P= .22) on 6-food elimination versus directed diets. After 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40% to 67% (milk, 40%; egg, 56%; soy, 64%; and wheat, 67%).
CONCLUSION
All 3 dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with 6-food elimination and skin test-directed diets. Notably, an empiric 6-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin test results.
背景
嗜酸性食管炎是一种慢性、免疫介导的炎症性疾病，对饮食治疗有反应；然而，评估饮食治疗策略有效性的数据有限。
目的
本研究比较了三种常用的饮食治疗方法（要素、6 食物剔除和皮肤点刺及过敏斑贴试验导向剔除饮食）的有效性，并评估了皮肤试验的缓解预测性及其在指导饮食计划中的作用。
方法
回顾性分析了质子泵抑制剂治疗无效、非糖皮质激素治疗的嗜酸性食管炎患者的队列研究，这些患者均接受了 2 次连续内镜活检，并进行了饮食干预。评估了饮食治疗和食物再引入后的组织学缓解情况（<15 个嗜酸性粒细胞/高倍视野）。
结果
在 513 名患者中，有 98 名符合入选标准。这 98 名患者中，分别有 50%（n=49）、27%（n=26）和 23%（n=23）接受了要素、6 食物剔除和导向饮食治疗。分别有 96%、81%和 65%的患者在接受要素、6 食物剔除和导向饮食治疗后出现缓解。与 6 食物剔除饮食相比，元素饮食诱导缓解的可能性高 5.6 倍（P=.05），与导向饮食相比，高 12.5 倍（P=.003），而与导向饮食相比，差异无统计学意义（P=.22）。在 116 次单食物再引入后，皮肤试验对缓解的阴性预测值为 40%至 67%（牛奶，40%；鸡蛋，56%；大豆，64%；和小麦，67%）。
结论
所有 3 种饮食治疗方法均有效；然而，与 6 食物剔除和皮肤试验导向饮食相比，要素饮食在诱导组织学缓解方面更有效。值得注意的是，经验性的 6 食物剔除饮食与皮肤试验导向饮食同样有效。在单食物挑战中最常引入的食物的阴性预测值不足以支持仅根据皮肤试验结果制定饮食推进计划。
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