Philpott Hamish, Dellon Evan
Northern Adelaide Local Health Network (NALHN), Department of Gastroenterology Lyell McEwin and Modbury Hospitals, University of Adelaide, Adelaide, Australia.
University of North Carolina at Chapel Hill School of Medicine, Division of Gastroenterology and Hepatology Center for Esophageal Diseases and Swallowing, Chapel Hill, NC, USA.
Asia Pac Allergy. 2018 Apr 25;8(2):e20. doi: 10.5415/apallergy.2018.8.e20. eCollection 2018 Apr.
Elimination diets are used to treat eosinophilic esophagitis (EoE), with success (remission) defined at endoscopy and oesophageal biopsy as fewer than 15 eosinophils per high power field (HPF). Response is assessed after 6 weeks of treatment by convention, but we have observed that this period of time may be insufficient.
To characterise a subset of patients with EoE who require prolonged (>6 weeks) of dietary therapy to achieve histologic remission.
A retrospective search of electronic medical records of 2 cohorts with EoE attending the Department of Gastroenterology, University of Chapel Hill North Carolina, and Eastern Health, Melbourne Australia. Patients who underwent elimination diet, had esophageal biopsy after 6 or more weeks of dietary restriction that demonstrated ongoing esophageal inflammation (>15 eosinophils per HPF), and who then continued dietary therapy followed by repeat endoscopy demonstrating remission (<15 eosinophils per HPF) were included.
Seven patients met inclusion criteria, average esophageal eosinophil counts prior to diet was 38.5 (range, 15-65). Following the initial period of diet (mean of 6 weeks and 4 days) eosinophil count decreased (average, 21.5/HPF; range 15-40/HPF). After extended dietary elimination (mean, 13 weeks; range, 7-22 weeks), histological resolution was achieved (average peak eosinophil count of 5.2; range, 0-14) in all cases. Endoscopic appearance and symptoms both improved following the initial period of dietary elimination, thereby preceding the histological resolution, and were sustained.
A subset of patients has full histologic response to prolonged elimination diet, that lags initial symptomatic and endoscopic improvement.
排除饮食法用于治疗嗜酸性粒细胞性食管炎（EoE），在内镜检查和食管活检中，以每高倍视野（HPF）嗜酸性粒细胞少于15个定义为成功（缓解）。按照惯例，在治疗6周后评估反应，但我们观察到这段时间可能不够。
描述一组需要延长（>6周）饮食治疗以实现组织学缓解的EoE患者。
对北卡罗来纳大学教堂山分校胃肠病学系和澳大利亚墨尔本东部健康中心的2个EoE队列的电子病历进行回顾性检索。纳入接受排除饮食法、在饮食限制6周或更长时间后进行食管活检显示存在持续食管炎症（每HPF>15个嗜酸性粒细胞）、然后继续饮食治疗并经重复内镜检查显示缓解（每HPF<15个嗜酸性粒细胞）的患者。
7例患者符合纳入标准，饮食前食管嗜酸性粒细胞平均计数为38.5（范围15 - 65）。在最初的饮食期（平均6周零4天）后，嗜酸性粒细胞计数下降（平均21.5/HPF；范围15 - 40/HPF）。在延长的饮食排除期（平均13周；范围7 - 22周）后，所有病例均实现了组织学缓解（嗜酸性粒细胞平均峰值计数为5.2；范围0 - 14）。在最初的饮食排除期后，内镜表现和症状均有所改善，早于组织学缓解，且持续存在。
一部分患者对延长的排除饮食法有完全的组织学反应，该反应滞后于最初的症状和内镜改善。
