Digestive Disease Week

Digestive Disease Week

July 24, 2018
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Six-food elimination diet helps maintain remission in pediatric EoE

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WASHINGTON — Identifying trigger foods through a six-food elimination diet helped children with eosinophilic esophagitis maintain long-term remission, according to research presented at Digestive Disease Week.

Salvatore Oliva, MD, of the Pediatric Gastroenterology and Liver Unit at the University of Rome, said PPIs, topical steroids and diet are all considered first-line treatment for EoE.

“Despite having great variability in terms of efficacy, ... we do not have comparative studies among these strategies,” he said in his presentation. “We performed a randomized controlled trial to assess the efficacy of the six-food elimination diet and different topical steroids in inducing and maintaining remission of pediatric EoE.”

Oliva and colleagues analyzed data from 50 patients younger than 18 years with active EoE who failed to achieve response to PPI therapy. They randomly assigned patients to receive one of four different treatments: the six-food elimination diet (n = 13), swallowed fluticasone (n = 12), swallowed budesonide (n = 12), and oral viscous budesonide (n = 13). The primary outcome of the study was percentage of responders defined by an eosinophil count of less than 15. Investigators assessed response at week 8 and week 42.

At 8 weeks of follow-up, Oliva and colleagues determined response rates for each group. The rate was 69% for the six-food elimination diet, 67% for swallowed fluticasone, 75% for swallowed budesonide, and 85% for oral viscous budesonide. At the end of the study, the percentage of patients who maintained remission were 61%, 42%, 33%, and 38% respectively.

Oliva said the steroids required repeated cycles to maintain long-term remission, while almost all the children who responded to diet maintained remission in the long-term.

“Surely in the short-term, both diet and steroids are effective in inducing remission,” Oliva said. “The diet is able to maintain remission. This is probably related to the fact that the diet includes both the concepts of induction and maintenance at the same time.” - by Alex Young

Reference:

Oliva S, et al. Abstract 786. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.

Disclosures: Oliva reports financial ties to Medtronic and Capsovision. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.