title: Comparative dietary therapy effectiveness in remission of pediatric eosinophilic esophagitis.
abstract: BACKGROUND
  Eosinophilic esophagitis is a chronic, immune-mediated inflammatory disorder that responds to dietary therapy; however, data evaluating the effectiveness of dietary therapeutic strategies are limited.
  
  
  OBJECTIVE
  This study compared the effectiveness of 3 frequently prescribed dietary therapies (elemental, 6-food elimination, and skin prick and atopy patch-directed elimination diets) and assessed the remission predictability of skin tests and their utility in directing dietary planning.
  
  
  METHODS
  A retrospective cohort of proton-pump inhibitor-unresponsive, non-glucocorticoid-treated patients with eosinophilic esophagitis who had 2 consecutive endoscopic biopsy specimens associated with dietary intervention was identified. Biopsy histology and remissions (<15 eosinophils/high-power field) after dietary therapy and food reintroductions were evaluated.
  
  
  RESULTS
  Ninety-eight of 513 patients met the eligibility criteria. Of these 98 patients, 50% (n= 49), 27% (n= 26), and 23% (n= 23) received elemental, 6-food elimination, and directed diets, respectively. Remission occurred in 96%, 81%, and 65% of patients on elemental, 6-food elimination, and directed diets, respectively. The odds of postdiet remission versus nonremission were 5.6-fold higher (P= .05) on elemental versus 6-food elimination diets and 12.5-fold higher (P= .003) on elemental versus directed diets and were not significantly different (P= .22) on 6-food elimination versus directed diets. After 116 single-food reintroductions, the negative predictive value of skin testing for remission was 40% to 67% (milk, 40%; egg, 56%; soy, 64%; and wheat, 67%).
  
  
  CONCLUSIONS
  All 3 dietary therapies are effective; however, an elemental diet is superior at inducing histologic remission compared with 6-food elimination and skin test-directed diets. Notably, an empiric 6-food elimination diet is as effective as a skin test-directed diet. The negative predictive values of foods most commonly reintroduced in single-food challenges are not sufficient to support the development of dietary advancement plans solely based on skin test results.
authors.affiliation: Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229-3039, USA.
authors.forename: Carol J
authors.initials: CJ
authors.lastname: Henderson
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Abonia
authors.forename: Eileen C
authors.initials: EC
authors.lastname: King
authors.forename: Philip E
authors.initials: PE
authors.lastname: Putnam
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Collins
authors.forename: James P
authors.initials: JP
authors.lastname: Franciosi
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rothenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004032:Diet; D057765:Eosinophilic Esophagitis / Q000178:diet therapy* / Q000473:pathology; D004804:Eosinophils; D004947:Esophagus / Q000473:pathology; D005260:Female; D005502:Food; D006801:Humans; D007223:Infant; D007958:Leukocyte Count; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult