Elimination Diet or Swallowed Topical Steroid Treatment of Pediatric Eosinophilic Esophagitis: Five-Year Outcomes.
Elimination Diet or Swallowed Topical Steroid Treatment of Pediatric Eosinophilic Esophagitis: Five-Year Outcomes.
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消除饮食或吞咽局部类固醇治疗小儿嗜酸性食管炎：五年结果。
DOI：
10.1016/j.jaip.2023.05.036
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Atkins,Dan
中科院分区：
文献类型：
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作者：
Nistel,Mason;Andrews,Rachel;Furuta,GlennT;Atkins,Dan
背景嗜酸性食管炎（EoE）是一种慢性、抗原介导的食管疾病，通常采用口服局部类固醇（STS）或消除饮食（EDs）治疗。儿科患者对ED的长期反应的证据是稀疏的。我们的研究试图了解仅用ED治疗的儿科EoE的自然史，并检查类似的STS治疗的EoE受试者人群。我们假设，长期坚持有效的艾德将导致正在进行的EoE疾病remission.MethodsWe进行了一项回顾性研究的儿童EoE受试者谁至少有2次访问一个多学科诊所。确定了以下受试者：（1）新转诊疑似诊断为EoE;（2）单独接受ED或STS治疗;（3）完成诊断和治疗后内镜检查。允许伴随使用质子泵抑制剂。我们收集了每个受试者的人口统计学资料、临床特征、治疗计划和相关副作用。缓解被定义为少于15嗜酸性粒细胞/高功率field.ResultsWe筛选的电子病历从2015年至2016年的胃肠道嗜酸性粒细胞疾病计划谁适合纳入本分析的标准照顾的主题。确定了199例受试者，16例接受了专门的ED，15例接受了STS治疗。这些受试者的治疗记录分别为4.8年和5.2年（P= .51）。两组在EoE诊断时的平均年龄（艾德3.5岁vs STS 7.8岁;P= 0.002）和内镜检查次数（艾德6.6例vs STS 4.5例;P= 0.03）方面存在显著差异。16例接受艾德治疗的受试者中有15例获得组织学缓解。初始有效艾德平均去除7.7种食物，最终艾德平均去除4种食物。艾德组无食物嵌塞或食管扩张。STS组需要平均3.7剂量/配方的变化，4名受试者需要1个或更多的扩张，1名受试者有2个食物嵌塞，2名被诊断为肾上腺功能不全。在这项研究中，艾德组的副作用比STS组少，但这一结论的有效性受到样本量小的限制，并加强了前瞻性研究的必要性，以探索这些初步的结果。
BackgroundEosinophilic esophagitis (EoE) is a chronic, antigen-mediated disease of the esophagus commonly treated with swallowed topical steroids (STS) or elimination diets (EDs). Evidence of a long-term response to EDs in pediatric patients is sparse.ObjectiveOur study sought to understand the natural history of pediatric EoE treated exclusively with EDs and to examine a similar population of STS-treated EoE subjects. We hypothesized that long-term adherence to an effective ED would result in ongoing EoE disease remission.MethodsWe conducted a retrospective study of pediatric EoE subjects who had at least 2 visits to a multidisciplinary clinic. Subjects were identified who had (1) a new referral with a suspected diagnosis of EoE; (2) received either EDs or STS alone, and (3) completed both a diagnostic and a posttreatment endoscopy. Concomitant proton-pump inhibitor use was allowed. We collected demographics, clinical features, treatment plans, and associated side effects on each subject. Remission was defined as fewer than 15 eosinophils/high-powered field.ResultsWe screened the electronic medical record from 2015 to 2016 for subjects cared for in the Gastrointestinal Eosinophilic Diseases Program who fit criteria for inclusion in this analysis. One hundred ninety-nine subjects were identified, 16 who received exclusive EDs and 15 who were treated with STS. Treatment of these subjects was documented for 4.8 and 5.2 years, respectively (P= .51). Significant differences between the groups were observed in average age at EoE diagnosis (3.5 y ED vs 7.8 y STS;P= .002) and in number of endoscopies (6.6 in ED vs 4.5 in STS;P= .03). Fifteen of 16 subjects treated with ED attained histological remission. The initial effective ED removed a mean of 7.7 foods and the final ED removed a mean of 4 foods. No food impactions or esophageal dilations occurred in the ED group. The STS group required an average of 3.7 dose/formulation changes, 4 subjects required 1 or more dilations, 1 subject had 2 food impactions, and 2 were diagnosed with adrenal insufficiency.ConclusionsTreatment with either ED or STS can lead to long-term remission of EoE. In this study, fewer side effects developed in the ED group than the STS group, but the validity of this conclusion is limited by the small sample size and reinforces the need for prospective study to explore these initial findings.