Dietary therapy can reverse esophageal subepithelial fibrosis in patients with eosinophilic esophagitis: a historical cohort.
BACKGROUND
Fibrosis of the esophageal lamina propria is a known complication of eosinophilic esophagitis (EoE). To date, therapy with topical corticosteroids has been shown to reverse esophageal fibrosis in some patients; however, there is little evidence to suggest that dietary therapy can also reverse it. Our aim was to examine whether dietary therapy alone can reverse esophageal fibrosis in children with EoE.


METHODS
We performed a historical cohort study based on children with EoE who had esophageal fibrosis on pretreatment biopsies using trichrome staining. Post-treatment biopsies were analyzed for fibrosis reversal, and results were compared between patients treated with dietary restriction and those that received topical steroids. Clinical characteristics (age, symptoms, duration of symptoms prior to therapy, treatment type, and duration of therapy) were recorded. Histological markers (eosinophil numbers and eosinophilic degranulation in both epithelium and lamina propria, basal zone hyperplasia, and the presence of eosinophilic microabscesses in the epithelium) were examined by reviewing hematoxylin and eosin-stained biopsies and by immunohistochemical staining. These were examined as potential predictors for fibrosis reversal.


RESULTS
Fibrosis resolved following both dietary restriction and topical steroids (3/17 and 5/9 patients respectively, P = 0.078). Post-treatment symptom resolution and decreased intraepithelial eosinophil numbers were found to be the only significant predictors of fibrosis resolution.


CONCLUSIONS
Dietary restriction alone, similar to topical steroids, can reverse fibrosis in children with EoE.
Division of Allergy and Immunology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY, USA.
J A
JA
Lieberman
R A
RA
Morotti
G N
GN
Konstantinou
O
O
Yershov
M
M
Chehade
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000473:pathology; D004848:Epithelium / Q000473:pathology*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005355:Fibrosis / Q000178:diet therapy* / Q000209:etiology* / Q000473:pathology; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
D000305:Adrenal Cortex Hormones