Sensitization to foods in gastroesophageal reflux disease and its relation to eosinophils in the esophagus: is it of clinical importance?
BACKGROUND
Refractory gastroesophageal reflux disease (GERD) can be related to greater sensitization to foods.


OBJECTIVE
To evaluate sensitization to foods in patients with refractory GERD.


METHODS
Patients with refractory GERD after using at least 40 mg of a proton pump inhibitor were given a restriction diet based on the results of skin prick testing and atopy patch testing with foods. The characteristics of sensitized patients were compared with those of nonsensitized patients in relation to atopy and number of eosinophils in the esophageal mucosa.


RESULTS
The prevalence of sensitization to foods was 27.7%. Asthmatic patients showed higher sensitization to foods (P = .008). Eosinophils were determined to be present in the esophageal mucosa in 15.8% of patients, and this correlated with greater sensitization to foods (P = .01). One case of eosinophilic esophagitis was confirmed. A diet excluding identified sensitizing foods led to clinical improvement regarding GERD symptoms (P = .004).


CONCLUSIONS
The presence of eosinophils in esophageal mucosa associated with greater sensitization to foods and the response to a restriction diet in patients with positive test results suggest that refractory GERD can represent an initial stage of eosinophilic esophagitis.
Division of Clinical Immunology and Allergy, University of São Paulo School of Medicine, São Paulo, Brazil. fabiane2212@yahoo.com.br
Fabiane
F
Pomiecinski
Ariana Campos
AC
Yang
Thomas
T
Navarro-Rodrigues
Jorge
J
Kalil
Fábio Fernandes Morato
FF
Castro
D000328:Adult; D004035:Diet Therapy; D057765:Eosinophilic Esophagitis; D004804:Eosinophils / Q000276:immunology / Q000378:metabolism* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005260:Female; D005502:Food / Q000009:adverse effects*; D005512:Food Hypersensitivity / Q000150:complications / Q000453:epidemiology / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy; D005764:Gastroesophageal Reflux / Q000150:complications / Q000453:epidemiology / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009092:Mucous Membrane / Q000276:immunology; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
D054328:Proton Pump Inhibitors