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N. Shah - One of the best experts on this subject based on the ideXlab platform.
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The impact on quality of life on families of children on an Elimination Diet for Non-immunoglobulin E mediated gastrointestinal food allergies.
The World Allergy Organization journal, 2017Co-Authors: Rosan Meyer, Adriana Chebar Lozinsky, Robert Dziubak, Heather Godwin, Kate Reeve, Julie A. Panepinto, Ru-xin M. Foong, Mandy Bryon, N. ShahAbstract:The impact on health related quality of life (HRQL) has been well studied in children with Immunoglobulin E (IgE)-mediated food allergy. However limited data exists on related quality of life (QOL) of families who have a child suffering from food protein induced non-IgE mediated gastrointestinal allergies. We aimed to establish the QOL of families with children at the beginning of following an Elimination Diet for non-IgE mediated gastrointestinal food allergies. A prospective, observational study was performed. Parents of children aged 4 weeks-16 years who improved after 4-8 weeks of following an Elimination Diet for suspected non-IgE mediated allergies were included. The Family Impact Module (FIM) of the Pediatric Quality of Life (PedsQL™) was used and we compared our data to two historical cohorts: one with sickle cell disease and another with intestinal failure. One hundred and twenty three children with a median age of 20 months were included (84 boys). The total FIM Score was 57.43 (SD 22.27) and particularly low for daily activities and worry. Factors that impacted significantly included age (p < 0.0001), number of foods excluded (p = 0.008), symptom severity (p = 0.041) and chronic nasal congestion (p = 0.012). Children with non-IgE mediated food allergies had worse scores in all domains (p < 0.0001) compared to sickle cell disease and worse physical (p = 0.04), emotional (p = 0.04) and worry (p = 0.01) domains compared to intestinal failure. This study found that parent QOL and family functioning was worse in those families who had a child on an Elimination Diet for non-IgE mediated allergies compared to those with sickle cell disease and intestinal failure, highlighting the impact this disease has on families.
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the impact of the Elimination Diet on growth and nutrient intake in children with food protein induced gastrointestinal allergies
Clinical and Translational Allergy, 2016Co-Authors: Rosan Meyer, Adriana Chebar Lozinsky, Claire De Koker, Robert Dziubak, Heather Godwin, Kate Reeve, Gloria Dominguezortega, Anakristina Skrapac, Yara Gholmie, N. ShahAbstract:Non immunoglobulin E (IgE) mediated allergies affecting the gastrointestinal tract require an Elimination Diet to aid diagnosis. The Elimination Diet may entail multiple food Eliminations that contribute significantly to macro- and micro-nutrient intake which are essential for normal growth and development. Previous studies have indicated growth faltering in children with IgE-mediated allergy, but limited data is available on those with delayed type allergies. We therefore performed a study to establish the impact on growth before and after commencing an Elimination Diets in children with food protein induced non-IgE mediated gastrointestinal allergies. A prospective, observational study was performed at the tertiary gastroenterology department. Children aged 4 weeks–16 years without non-allergic co-morbidities who were required to follow an Elimination Diet for suspected food protein induced gastrointestinal allergies were included. Growth parameters pre-Elimination were taken from clinical notes and post-Elimination measurements (weight and height) were taken a minimum of 4 weeks after the Elimination Diet. A 3-day estimated food diary was recorded a minimum of 4 weeks after initiating the Elimination Diet, including also any hypoallergenic formulas or over the counter milk alternatives that were consumed. We recruited 130 children: 89 (68.5 %) boys and a median age of 23.3 months [IQR 9.4–69.2]. Almost all children (94.8 %) in this study eliminated CM from their Diet and average contribution of energy in the form of protein was 13.8 % (SD 3.9), 51.2 % (SD 7.5) from carbohydrates and 35 % (SD 7.5) from fat. In our cohort 9 and 2.8 % were stunted and wasted respectively. There was a statistically significant improvement in weight-for-age (Wtage) after the 4 week Elimination Diet. The Elimination Diet itself did not improve any of the growth parameters, but achieving energy and protein intake improved Wtage and WtHt respectively, vitamin and/or mineral supplements and hypoallergenic formulas were positively associated with WtHt and Wtage. With appropriate Dietary advice, including optimal energy and protein intake, hypoallergenic formulas and vitamins and mineral supplementation, growth parameters increased from before to after Dietary Elimination. These factors were positively associated with growth, irrespective of the type of Elimination Diet and the numbers of foods eliminated.
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time to symptom improvement using Elimination Diets in non ige mediated gastrointestinal food allergies
Applied Immunohistochemistry & Molecular Morphology, 2015Co-Authors: Adriana Chebar Lozinsky, Rosan Meyer, Claire De Koker, Robert Dziubak, Heather Godwin, Kate Reeve, Gloria Dominguez Ortega, N. ShahAbstract:AbstractBackground: The prevalence of food allergy has increased in recent decades, and thereis paucity of data on time to symptom improvement using Elimination Diets in non-Immunoglobulin E (IgE)-mediated food allergies. We therefore aimed to assess thetime required to improvement of symptoms using a symptom questionnaire forchildren with non-IgE-mediated food allergies on an Elimination Diet.Methods: A prospective observational study was performed on patients with non-IgE-mediated gastrointestinal food allergies on an Elimination Diet, who completed aquestionnaire that includes nine evidence-based food allergic symptoms before andafter the exclusion Diet. The questionnaire measured symptoms individually from 0 (nosymptom) to 5 (most severe) and collectively from 0 to 45. Children were only enrolledin the study if collectively symptoms improved with the Dietary Elimination within 4 or8 weeks.Results: Data from 131 patients were analysed including 90 boys with a median age of21 months [IQR: 7 to 66]. Based on the symptom questionnaire, 129 patients (98.4%)improved after 4-week Elimination Diet and only two patients improved after 8 weeks.A statistically significant difference before and after commencing the Elimination Dietwas seen in all nine recorded symptoms (all p < 0.001), and in the median of overallscore (p < 0.001).Conclusion: This is the first study attempting to establish time to improve aftercommencing the Diet Elimination. Almost all children in this study improved within4 weeks of following the Elimination Diet, under Dietary supervision.The prevalence of food allergy in the paediatric population hasincreased in recent decades and is recognized as a significantpublic health problem (1, 2). The major causative food antigensin children are cow’s milk, hen’s egg, soya, wheat, peanuts, treenuts and fish/seafood. In the United Kingdom (UK), studieshave found that between 2.2 and 5.5% of the infants in the firstyear of life present with proven food allergies (3), with theprevalence of cow’s milk protein allergy (CMPA) rangingbetween 1.9 and 4.9% (4) and for egg and soya 2% (5) and1.9%, respectively (6).According to the recent guideline from the NationalInstitute of Allergy and Infectious Disease (NIAID), foodallergy can be classified into three groups: IgE-mediated, non-IgE-mediated and mixed IgE and non-IgE-mediated (2). Thepathogenesis of IgE-mediated food allergy is well character-ized, with symptoms occurring immediately and up to 2 h afteringestion. The allergy-focused history, in addition to either skin
Nirmala Gonsalves - One of the best experts on this subject based on the ideXlab platform.
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Assessing Adherence and Barriers to Long-Term Elimination Diet Therapy in Adults with Eosinophilic Esophagitis.
Digestive diseases and sciences, 2018Co-Authors: Ryan Wang, Nirmala Gonsalves, Bethany Doerfler, Ikuo Hirano, Angelika Zalewski, Tiffany TaftAbstract:The six-food Elimination Diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients' quality of life. Assess patients' long-term adherence to SFED and potential factors influencing adherence. EoE patients were recruited online via multiple platforms. Patients were classified as reaching the maintenance stage if they responded to SFED and identified specific trigger foods by reintroduction. Maintenance stage patients were categorized into those actively following the Elimination Diet (ACTIVE) and those no longer on their prescribed Diet (FORMER). Participants completed a study-specific questionnaire assessing patient experiences related to SFED use. Forty-two participants were identified as having reached the SFED's maintenance stage. 57% (24/42) of the maintenance stage patients were ACTIVE users. FORMER users rated the SFED's effectiveness at treating symptoms (5.45 ± 3.96, 10 max.) lower than ACTIVE users (8.29 ± 2.76, p = .02). A greater percentage of FORMER users (100%) agreed social situations create challenges in following the Diet compared to ACTIVE users (67%, p < .05). Anxiety related to SFED was also higher among FORMER users (64%) compared to ACTIVE users (21%, p < .01). Both ACTIVE (95.8%) and FORMER (81.8%, NSS) users would recommend the Elimination Diet to other EoE patients. Understanding SFED adherence is multifactorial and complex. Factors influencing SFED adherence during long-term maintenance with Diet therapy include Diet effectiveness, social situations, and Diet-related anxiety. Despite a lower than expected long-term adherence to maintenance of an Elimination Diet, the majority would recommend Diet therapy as a treatment to other EoE patients.
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assessing adherence and barriers to long term Elimination Diet therapy in adults with eosinophilic esophagitis
Digestive Diseases and Sciences, 2018Co-Authors: Ryan Wang, Nirmala Gonsalves, Bethany Doerfler, Ikuo Hirano, Angelika Zalewski, Tiffany TaftAbstract:Background The six-food Elimination Diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients’ quality of life.
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should wheat barley rye and or gluten be avoided in a 6 food Elimination Diet
The Journal of Allergy and Clinical Immunology, 2016Co-Authors: Kara Kliewer, Evan S. Dellon, Carina Venter, Alison M Cassin, Pablo J Abonia, Seema S Aceves, Peter A Bonis, Gary W Falk, Glenn T Furuta, Nirmala GonsalvesAbstract:Eosinophilic esophagitis (EoE), a food antigen-mediated disease, is effectively treated with the Dietary Elimination of 6 foods commonly associated with food allergies (milk, wheat, egg, soy, tree nuts/peanuts, and fish/shellfish). Because wheat shares homologous proteins (including gluten) with barley and rye and can also be processed with these grains, some clinicians have suggested that barley and rye might also trigger EoE as a result of cross-reaction and/or cross-contamination with wheat. In this article, we discuss the theoretical risks of cross-reactivity and cross-contamination among wheat, barley, and rye proteins (including gluten); assess common practices at EoE treatment centers; and provide recommendations for Dietary treatment and future studies of EoE.
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Elimination Diet effectively treats eosinophilic esophagitis in adults food reintroduction identifies causative factors
Gastroenterology, 2012Co-Authors: Nirmala Gonsalves, Bethany Doerfler, Sally Ritz, Guang Yu Yang, Anne Marie Ditto, Ikuo HiranoAbstract: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. Methods 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. Results 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 P P Conclusions 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.
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clinical alimentary tract Elimination Diet effectively treats eosinophilic esophagitis in adults food reintroduction identifies causative factors
2012Co-Authors: Nirmala Gonsalves, Bethany Doerfler, Sally Ritz, Anne Marie Ditto, Ikuo HiranoAbstract: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
Muneaki Matsuo - One of the best experts on this subject based on the ideXlab platform.
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endoscopic findings of eosinophilic esophagitis successfully treated with a short term 6 food group Elimination Diet and reintroduction therapy
Postgraduate Medical Journal, 2020Co-Authors: Toshihiko Kakiuchi, Aiko Nakayama, Muneaki MatsuoAbstract:We reported a case of eosinophilic oesophagitis (EoE) treated with short-term 6-food-group Elimination Diet and reintroduction therapy.1 Elimination Diet and reintroduction therapies for EoE are usually performed for 6 to 8 weeks and a 2-week observation period, respectively.2 Our method was implemented in 5 days each. A 12-year-old girl was referred with a history of epigastric pain of 3-year duration. Eesophagogastroduodenoscopy (EGD) …
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Efficacy of a Short-term Six-food Elimination Diet and Reintroduction Therapy in Pediatric Eosinophilic Gastroenteritis.
Internal medicine (Tokyo Japan), 2020Co-Authors: Toshihiko Kakiuchi, Aiko Nakayama, Jun Abe, Muneaki MatsuoAbstract:A 13-year-old boy presented to the hospital with a 3-month history of repeated vomiting and abdominal pain. Results of esophagogastroduodenoscopy revealed a diagnosis of eosinophilic gastroenteritis (EGE). We initiated a short-term six-food Elimination Diet (SFED) and reintroduction therapy over five days. On the third day of SFED, the patient's abdominal symptoms completely disappeared. However, he experienced unbearable abdominal pain six hours after the reintroduction of milk and peanuts. His symptoms remain completely controlled at present after eliminating milk and peanut products. The SFED and reintroduction therapy for EGE may be effective even for short-term treatments over a five-day period.
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pediatric eosinophilic esophagitis effectively treated with a short term 6 food group Elimination Diet and reintroduction therapy a case report
Medicine, 2019Co-Authors: Toshihiko Kakiuchi, Aiko Nakayama, Muneaki MatsuoAbstract:RATIONALE Eosinophilic esophagitis (EoE) is an inflammatory disease diagnosed based on clinical symptoms and pathological findings. EoE is treated with proton pump inhibitors (PPIs), topical steroids, and Elimination Diet-reintroduction therapy. After remission is achieved with the Elimination Diet, foods can be reintroduced sequentially to identify specific food triggers; however, this reintroduction method was not previously standardized. PATIENT CONCERNS A 12-year-old girl presented to our hospital with a 3-year history of epigastric pain. Esophagogastroduodenoscopy revealed linear furrows, esophageal rings, white exudates, and pallor throughout the esophagus. Histopathological findings revealed eosinophilic infiltration >15 eos/hpf on esophageal biopsy. There were no obvious abnormal findings in the stomach and duodenum. DIAGNOSES EoE INTERVENTIONS AND OUTCOMES:: Because PPI was ineffective, we proposed a 6-food-group Elimination Diet (SFGED) and reintroduction therapy for EoE, which was initially planned out over a 6-week interval. However, a 5-day interval of SFGED and reintroduction therapy was performed instead. The treatment was effective and causative food antigens (egg and nuts) were identified. Since her symptoms recovered following short-term treatment, the nutritional impact was minimized, as was the duration of her hospitalization. Consequently, the patient's quality of life was well-preserved. LESSONS SFGED and reintroduction therapy for EoE may be effective even for short-term treatments involving 5-day intervals.
Evan S. Dellon - One of the best experts on this subject based on the ideXlab platform.
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combination therapy with Elimination Diet and corticosteroids is effective for adults with eosinophilic esophagitis
Clinical Gastroenterology and Hepatology, 2019Co-Authors: Craig C. Reed, Swathi Eluri, Manaswita Tappata, Nicholas J Shaheen, Evan S. DellonAbstract:Eosinophilic esophagitis (EoE) is a chronic immune/antigen-mediated disorder defined by eosinophilic-predominant inflammation and esophageal dysfunction.1,2 EoE represents an important cause of esophageal morbidity and a leading cause of esophagitis.3.
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Combined and Alternating Topical Steroids and Food Elimination Diet for the Treatment of Eosinophilic Esophagitis
Digestive diseases and sciences, 2018Co-Authors: Craig C. Reed, Anca Safta, Shadi Qasem, M. Angie Almond, Evan S. Dellon, Elizabeth T. JensenAbstract:Few studies have examined combined or alternating treatment algorithms in eosinophilic esophagitis. 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. 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. 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. 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.
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Six-Food Elimination Diet and Topical Steroids are Effective for Eosinophilic Esophagitis: A Meta-Regression.
Digestive diseases and sciences, 2017Co-Authors: Cary C. Cotton, Swathi Eluri, W. Asher Wolf, Evan S. DellonAbstract:Topical corticosteroids or six-food Elimination Diet is recommended as initial therapy for eosinophilic esophagitis (EoE). We aimed to summarize published manuscripts that report outcomes of these therapies for EoE. We performed a systematic review in MEDLINE, Web of Science, and Embase of published manuscripts describing topical fluticasone, topical budesonide, and six-food Elimination Diet as therapies for EoE. We conducted meta-analysis of symptom improvement and the change in peak mucosal eosinophil count, with heterogeneity between studies examined with meta-regression analysis. Systematic review yielded 51 articles that met inclusion criteria. Summary histologic response rates were 68.3% [95% prediction limits (PL) 16.2-96.0%] for fluticasone, 76.8% (95% PL 36.1-95.1%) for budesonide, and 69.0% (95% PL 31.9-91.4%) for six-food Elimination Diet. Corresponding decreases in eosinophil counts were 37.8 (95% PL 19.0-56.7), 62.5 (95% PL 125.6 to -0.67, and 44.6 (95% PL 26.5-62.7), respectively. Symptom response rates were 82.3% (95% PL 68.1-91.1%), 87.9% (95% PL 42.7-98.6%), and 87.3% (95% PL 64.5-96.3%), respectively. Meta-regression analyses decreased the initially large estimate of residual heterogeneity and suggested differences in histologic response rate associated with study populations' baseline eosinophil count and age. The literature describing topical corticosteroids and six-food Elimination Diet consists of small studies with diverse methods and population characteristics. Meta-analysis with meta-regression shows initial histologic and symptomatic response rates on the same order of magnitude for topical corticosteroids and six-food Elimination Diet, but heterogeneity of study designs prevents direct comparison of modalities.
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The Six-Food Elimination Diet for Eosinophilic Esophagitis Increases Grocery Shopping Cost and Complexity
Dysphagia, 2016Co-Authors: W. Asher Wolf, Kevin Z. Huang, Raquel Durban, Zahra Iqbal, Benjamin S. Robey, Farah J. Khalid, Evan S. DellonAbstract:The six-food Elimination Diet (SFED), where dairy, wheat, eggs, soy, nuts, and seafood are avoided, is an effective treatment for eosinophilic esophagitis (EoE). Patient-related costs of this approach, however, are unknown. We aimed to assess the cost of and ease of shopping for an SFED compared to an unrestricted Diet. A Dietitian with expertise in EoE generated menus meeting Dietary requirements for a week’s worth of meals for the SFED and an unrestricted Diet. We compared prices and the number of missing items for both Diets at standard and specialty grocery stores. The average weekly price of the SFED at a standard supermarket was $92.54 compared to $79.84 for an unrestricted Diet (p = 0.0001). A patient shopping at a standard grocery store needed a higher proportion of items from a second store compared to an unrestricted Diet (32 vs. 3 %, p = 0.0001). The prices of the SFED and unrestricted Diet using a specialty supermarket were comparable ($106.47 vs. $105.96, p = 0.81), as was the percentage of items requiring a trip to a second store (6 vs. 2 % items, p = 0.03). Shopping at a specialty grocery store increased weekly grocery costs by $13.93 (p = 0.04) for the SFED and $26.12 (p = 0.03) for the unrestricted Diet. In conclusion, for patients shopping at standard grocery stores, the cost of an SFED is higher, and an SFED requires more items from a second store. These differences disappear at specialty grocery stores, but costs were significantly higher. This cost and logistical burden can inform patients when selecting Dietary therapy.
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should wheat barley rye and or gluten be avoided in a 6 food Elimination Diet
The Journal of Allergy and Clinical Immunology, 2016Co-Authors: Kara Kliewer, Evan S. Dellon, Carina Venter, Alison M Cassin, Pablo J Abonia, Seema S Aceves, Peter A Bonis, Gary W Falk, Glenn T Furuta, Nirmala GonsalvesAbstract:Eosinophilic esophagitis (EoE), a food antigen-mediated disease, is effectively treated with the Dietary Elimination of 6 foods commonly associated with food allergies (milk, wheat, egg, soy, tree nuts/peanuts, and fish/shellfish). Because wheat shares homologous proteins (including gluten) with barley and rye and can also be processed with these grains, some clinicians have suggested that barley and rye might also trigger EoE as a result of cross-reaction and/or cross-contamination with wheat. In this article, we discuss the theoretical risks of cross-reactivity and cross-contamination among wheat, barley, and rye proteins (including gluten); assess common practices at EoE treatment centers; and provide recommendations for Dietary treatment and future studies of EoE.
Ikuo Hirano - One of the best experts on this subject based on the ideXlab platform.
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assessing adherence and barriers to long term Elimination Diet therapy in adults with eosinophilic esophagitis
Digestive Diseases and Sciences, 2018Co-Authors: Ryan Wang, Nirmala Gonsalves, Bethany Doerfler, Ikuo Hirano, Angelika Zalewski, Tiffany TaftAbstract:Background The six-food Elimination Diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients’ quality of life.
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Assessing Adherence and Barriers to Long-Term Elimination Diet Therapy in Adults with Eosinophilic Esophagitis.
Digestive diseases and sciences, 2018Co-Authors: Ryan Wang, Nirmala Gonsalves, Bethany Doerfler, Ikuo Hirano, Angelika Zalewski, Tiffany TaftAbstract:The six-food Elimination Diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients' quality of life. Assess patients' long-term adherence to SFED and potential factors influencing adherence. EoE patients were recruited online via multiple platforms. Patients were classified as reaching the maintenance stage if they responded to SFED and identified specific trigger foods by reintroduction. Maintenance stage patients were categorized into those actively following the Elimination Diet (ACTIVE) and those no longer on their prescribed Diet (FORMER). Participants completed a study-specific questionnaire assessing patient experiences related to SFED use. Forty-two participants were identified as having reached the SFED's maintenance stage. 57% (24/42) of the maintenance stage patients were ACTIVE users. FORMER users rated the SFED's effectiveness at treating symptoms (5.45 ± 3.96, 10 max.) lower than ACTIVE users (8.29 ± 2.76, p = .02). A greater percentage of FORMER users (100%) agreed social situations create challenges in following the Diet compared to ACTIVE users (67%, p < .05). Anxiety related to SFED was also higher among FORMER users (64%) compared to ACTIVE users (21%, p < .01). Both ACTIVE (95.8%) and FORMER (81.8%, NSS) users would recommend the Elimination Diet to other EoE patients. Understanding SFED adherence is multifactorial and complex. Factors influencing SFED adherence during long-term maintenance with Diet therapy include Diet effectiveness, social situations, and Diet-related anxiety. Despite a lower than expected long-term adherence to maintenance of an Elimination Diet, the majority would recommend Diet therapy as a treatment to other EoE patients.
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Elimination Diet effectively treats eosinophilic esophagitis in adults food reintroduction identifies causative factors
Gastroenterology, 2012Co-Authors: Nirmala Gonsalves, Bethany Doerfler, Sally Ritz, Guang Yu Yang, Anne Marie Ditto, Ikuo HiranoAbstract: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. Methods 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. Results 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 P P Conclusions 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.
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clinical alimentary tract Elimination Diet effectively treats eosinophilic esophagitis in adults food reintroduction identifies causative factors
2012Co-Authors: Nirmala Gonsalves, Bethany Doerfler, Sally Ritz, Anne Marie Ditto, Ikuo HiranoAbstract: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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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s1861 a prospective clinical trial of six food Elimination Diet or elemental Diet in the treatment of adults with eosinophilic gastroenteritis
Gastroenterology, 2009Co-Authors: Nirmala Gonsalves, Bethany Doerfler, Guang Y Yang, Ikuo HiranoAbstract:Background: Eosinophilic gastroenteritis (EG) is a rare disorder whose pathogenesis is poorly understood. To date there are no reports of Dietary Elimination in adults with EG. Aim: To evaluate the effectiveness of therapy with six food Elimination Diet (SFED) or elemental Diet (ED) in adults with EG. Methods: Adults with a histologic diagnosis of EG were treated with either SFED or ED for 6 wks. All pts were off steroid or immunomodulators prior to inclusion and during the study period and were ruled out for H pylori and other infections. Pts met with a Dietician for counseling and compliance. After 6 wks, pts had repeat EGD with biopsies in the proximal/distal esophagus, stomach and duodenum. Response was defined as peak count < 5 eos/hpf in the esophagus and <10 eos/hpf in gastric or duodenal specimens. If pts did not respond to SFED, they were offered 6 wks of ED. Results: 9 pts (6M) have been included to date. Average age was 35yrs (27-49) with median duration of symptoms of 13.5yrs (0.25-37). All pts had gastric involvement and 3/9 and 6/9 pts also had duodenal and esophageal eosinophilia, respectively. Common symptoms were abdominal pain (7), diarrhea (4), weight loss (4), dysphagia (4) nausea/vomiting (3) and fatigue (3). Complications of EG included anemia (4), malnutrition (2), osteoporosis (2) non-healing ulcer disease (1) and duodenal stricture (1). 89% of pts were atopic and 44% had history of food allergies. Skin prick testing for aero and food allergens were positive in 100% of the 77% of pts tested. Endoscopic findings were gastric erythema (100%) and nodularity (56%), duodenal erythema (22%) and nodularity (11%). All pts with dysphagia had features consistent with eosinophilic esophagitis (EoE) including rings (75%) furrows (75%), small caliber (50%), and stricture (25%). Diagnosis of EG preceded EoE in 50% of EG+EoE pts by an average of 10 yrs. No pts with pre-existing EoE progressed to EG. 89% of pts had peripheral eosinophilia (absolute eosinophil counts 1100-3900k/ul). IgE levels were high in 4/6 pts tested. 7/9 pts were initially treated with SFED and 2 pts with ED. 4/7 pts on SFED and 2/2 pts on ED had resolution of symptoms, histologic and peripheral eosinophilia. The remaining 3 pts on SFED had symptomatic but not histologic improvement, therefore are now undergoing ED. Conclusions: (1) Dietary Elimination is effective in reducing symptoms, histologic and peripheral eosinophilia in 4/7 EG adults on SFED and 2/2 on ED implicating food allergens in the etiopathogenesis. (2) Further trials of Dietary Elimination in adults with EG are warranted.