Open AccessCombination Steroid and Test‐based Food Elimination for Eosinophilic Esophagitis
Author(s) -
Constantine Gregory,
Seth Neha,
Chokshi Niti,
Minard Charles G.,
Guffey Danielle,
Olive Anthony P.,
Davis Carla M.
Publication year - 2017
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0000000000001584
Subject(s) - medicine , eosinophilic esophagitis , combination therapy , confidence interval , gastroenterology , exact test , corticosteroid , odds ratio , logistic regression , esophagitis , high power field , retrospective cohort study , esophagus , surgery , disease , reflux , immunohistochemistry
Objectives: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized by infiltration of eosinophils into the esophagus. Primary treatment approaches include topical corticosteroids and/or food elimination. The aim of the present study was to compare the effectiveness of combination therapy (topical corticosteroid plus test‐based food elimination [FS]) with single therapy (topical corticosteroid [S] or test‐based food elimination [F]). Methods: Chart review of patients with EoE at Texas Children's Hospital (age <21 years) was performed. Clinical and histological statuses were evaluated after a 3‐month treatment with either single or combination therapy. Comparisons were analyzed using Fisher exact test, Kruskal‐Wallis tests, and multiple logistic regression models. Results: Among 670 charts, 63 patients (1–21 years, median 10.3 years) with clinicopathologic diagnoses of EoE were identified. Combination FS therapy was provided to 51% (n = 32) and single treatment (S, F) to 27% (n = 17) or 22% (n = 14) of patients, respectively. Clinical responses were noted in 91% (n = 29), 71% (n = 12), and 64% (n = 14) of patients in the FS, S, and F groups, respectively. The odds of clinically improving were 4.6 times greater (95% confidence interval: 1.1–18.8) with combination versus single therapy. The median peak number of eosinophils per high‐power field after 3‐month therapy was not significantly different in the S, F, and FS groups. Conclusions: The combination of topical corticosteroids with specific food elimination is as effective in achieving clinical and histological remissions as the single‐treatment approaches. Responses were achieved with the combination in patients who had previously failed single‐agent therapy. Prospective research of this combination approach in young patients with EoE is needed.