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310 - Efficacy of Cytosponge Directed Food Elimination Diet in Eosinophilic Esophagitis. a Pilot Trial

2018; Elsevier BV; Volume: 154; Issue: 6 Linguagem: Inglês

10.1016/s0016-5085(18)30705-4

1528-0012

Jeffrey A. Alexander, David A. Katzka, Karthik Ravi, Rebecca C. Fitzgerald, Debra M. Geno, Crystal Tholen, Ryan J. Lennon, Sarah Kruse, Kari L. Olson,

Eosinophilic Esophagitis

Introduction:A six food elimination diets (SFED) directed by endoscopically obtained esophageal histology is effective in the treatment of eosinophilic esophagitis (EoE) but requires multiple endoscopies which are inconvenient and costly.Aim: To determine if diet directed therapy assessed by the esophageal cytosponge results is accurate and feasible in EoE.Methods: We prospectively evaluated food reintroduction directed by the cytosponge in SFED responders.Patients found to be in histologic remission based on peak eosinophil levels obtained by EGD and esophageal biopsy (<15 eos/hpf ) after six weeks of the SFED ( fish, nuts, eggs, soy, wheat, dairy) diet were enrolled.A cytosponge was performed after 2 weeks of food introduction and to confirm remission after 6 weeks of food removal with trigger foods until the diet antigen triggers were determined.Cytosponge and EGD with biopsy were performed 4 weeks after completing cytosponge directed dietary reintroduction.In addition to accuracy, EREFS, symptoms, cost, complications, and patient preferences were compared to endoscopic management.Results: 14 patients underwent cytosponge directed food reintroduction.10 patients completed the 4-week post reintroduction EGD.The mean age was 44 (50% male) with a history of allergic disease 57%, GERD 29%, and food impaction 79%.The mean minimal and maximal esophageal diameter by structured barium esophagram was 13.0 and 18.5mm respectively.57% of patients underwent esophageal dilation during the evaluation.A mean of 6.6 studies/patient were required.All patients completed the cytosponge studies without significant difficulty.Dietary triggers identified were: fish 0%, nuts 8%, eggs 8%, soy 8%, wheat 46%, dairy 77%, no trigger 8%.At 4 weeks after food reintroduction was completed all patients were eating an unlimited food texture diet and had no dysphagia over the last two weeks.The final EGD histology and cytosponge agreed in 80% (8/10) patients (5 (-), 3 (+) and disagreed in 20%(2/10) (both sponge (-), histology (+); one of these patients had 16 eos/hpf).The EREFS scores pre-SFED restriction was 2.6; pre-food reintroduction and at study end were 1.0, 1.2 respectively (p=0.95).The Eosinophilic Esophagitis Activity Index pre-SFED was 42.0; pre-food reintroduction and at study end were 19.2, 8.8 respectively (p=0.10).The mean estimated direct cost for cytosponge directed dietary reintroduction was $1201 ($182/procedure) compared to $5795 ($878/procedure) if EGD and histology were to be performed .There were no clinical complications, no abrasions seen on post-sponge EGD, and all patients undergoing cytosponge evaluation favored the ctyosponge to EGD.Conclusions: This pilot study demonstrates that cytosponge directed food reintroduction is accurate, safe and relatively inexpensive when compared to endoscopy. .