A food elimination diet is a viable alternative therapy for eosinophilic esophagitis that responds to proton pump inhibitors. BMC Gastroenterology Department

participant

Using the EoE ICD-10 code K20.0, we identified 405 EoE patients. Of the 405 patients, 126 were excluded because they were diagnosed and started treatment plans elsewhere.Of her remaining 279 patients, 176 patients have tried her PPI monotherapy, of whom 107 of her patients are EoE histologically unresponsive to her PPI monotherapy and 69 patients had her EoE^PPI+Of these 69 patients, 22 patients were enrolled in the retrospective cohort as they tried FED monotherapy after discontinuing PPI monotherapy (Fig. 1).The median age of these 22 patients he was 34 years (IQR 29.2–39.7, Table 1), 13 men (59.09%, table) 1table S1).

Flowchart of patients included in retrospective cohorts based on inclusion criteria and prospective cohorts based on voluntary enrollment

Percentage of EoE patients who responded to PPI monotherapy and also responded to FED monotherapy

In phase 1 of our study, all 22 patients were diagnosed with histologically confirmed EoE (median peak eosinophil count 47.5 eos/hpf, IQR 26.25–83.75; Table 2).All patients were symptomatic and most suffered from dysphagia (81.82%, Table 2). All 22 patients responded histologically to PPI monotherapy, although dose and frequency varied among patients.Her most common PPI monotherapy was omeprazole 40 mg twice daily (63.64%, Table 1). Most patients were asymptomatic while receiving PPI monotherapy (63.64%, Table 2).However, reported symptoms included dysphagia (22.73%, Table 2), heartburn (13.64%, table 2), vomiting (4.55%, table 2), abdominal pain (4.55%, table 2), and regurgitation (4.55%, table 2).Her EGD while the patient was on her PPI monotherapy revealed a median peak eosinophil count of 2.5 eos/hpf (IQR 0–6, Table 2), significantly less than baseline (median 47.5, IQR 26.25–83.75; Fig. 2table S1).

(a) all 22 patients with EoE responding to PPI monotherapy who attempted FED monotherapy in the retrospective phase of our study, and (B.) 13 patients with EoE who histologically responded to PPI monotherapy and FED monotherapy. a Peak eosinophil count per baseline high-power field (median 47.5, IQR 26.25–83.75) vs. after PPI monotherapy (median 2.5, IQR 0–6), FED monotherapy (median 10, IQR 2.25) –30). B. Peak eosinophil count per baseline high-power field (median 38, IQR 20–85) vs. after PPI monotherapy (median 1, IQR 0–4), after FED monotherapy (median 6, IQR 1 -Ten). Error bars represent interquartile range. Paired comparisons were performed using the Wilcoxon Signed Rank Test. *** teeth p< 0.001

All 22 patients tried FED monotherapy after discontinuing PPI monotherapy.Although the patient received a variety of her FEDs, the most popular were her FEDs for dairy and wheat (2 food elimination diets, 2 FEDs; 68.18%; Table 1). Most patients receiving FED monotherapy are reported to be asymptomatic (68.18%, Table 2).Symptomatic patients reported heartburn (22.73%, Table 2) and dysphagia (18.18%, Table 2). During FED monotherapy, the median peak eosinophil count in these 22 patients was 10 eos/hpf (IQR 2.25–30; Table 2table S1).

out of 22 EoE^PPI+ Thirteen patients (59.09%; Fig. 1) was determined to have an EoE^{PPI+, FED+}9 patients (40.91%; Fig. 1) did not achieve histologic remission of EoE on FED monotherapy (EoE with histologic remission on PPI monotherapy, but not on FED monotherapy, EoE, EoE^{PPI+, FED−}). 13 EoE^{PPI+, FED+} Patients had a median peak eosinophil count of 6 eos/hpf (IQR 1–10, Table 2) significantly less than at baseline during FED monotherapy (median 38, IQR 20-85; Fig. 2table S1).

Future within-cohort observations

Following the trial of FED monotherapy, 15 of the total 22 patients were voluntarily enrolled in a prospective cohort for observation in phase 2 of the study.Of these 15 participants of his, 9 were her EoE^{PPI+, FED+} and six were EoE^{PPI+, FED−} (fig. 1).During this observation period, patients with EoE^{PPI+, FED−} Resume PPI monotherapy and EoE^{PPI+, FED+} Patients were given the option of returning to PPI monotherapy, continuing FED monotherapy, or starting FED monotherapy with PPI, as needed. Median EoE follow-up^{PPI+, FED+} The patient was 2.25 years old (IQR 1.51–2.48, Table 3), and median follow-up for EoE^{PPI+, FED−} The patient was 1.08 years old (IQR 0.73–2.38; Table 3table S2).

During the observation period, we recorded patients’ healthcare utilization due to exacerbations during maintenance treatment or trials of other treatment regimens for EoE.Healthcare utilization was similar across his EoE^{PPI+, FED+} and EoE^{PPI+, FED−} Patience.None of the patients had a food effect warranting urgent her EGD or exacerbation of symptoms requiring urgent follow-up (Table 3). His 1 patient with EoE^{PPI+, FED+} (11.11%, table 3) and two EoE^{PPI+, FED−} Patients (33.33%, table 3) underwent repeated EGD during the maintenance treatment plan for histologic reevaluation.None of these patients showed histologic reactivation of her EoE during the maintenance regimen (Table 3). 4 EoEs^{PPI+, FED+} Patients (44.44%, table 3) and four EoE^{PPI+, FED−} Patients (66.67%; table 3table S2) repeated EGD for histological evaluation of other treatment regimens. These his EGDs showed his EoE histologically reactivated, so the patient resumed the maintenance treatment regimen according to these demonstrative studies.

Qualitative results from prospective cohorts

After an observation period, all 15 patients in the prospective cohort completed a 3-item survey.When asked why they continued with the FED monotherapy trial after learning that their EoE was responding to her PPI therapy, the majority of patients (60%, table Four) were concerned about long-term drug use. Other patients said they suspected side effects from PPI monotherapy (13.33%), wanted to discover food triggers (20%), or wanted future treatment options (6.67%). If a trial of FED monotherapy was considered after achieving histologic remission on PPI monotherapy, the majority of patients would recommend this process to others with EoE (93.33%), personal said they would go through this process again (80%).

9 patients who had EoE^{PPI+, FED+} Responded to additional surveys. Given the histological remission achieved with PPI monotherapy and FED monotherapy, patients had the option of a maintenance treatment plan.The majority of patients decided to continue FED monotherapy (55.56%, Table Five), some chose to switch to FED monotherapy with a PPI if needed (33.33%, Table Five), others reverted to PPI monotherapy (11.11%, Table Five).When asked why they followed a particular maintenance treatment plan over other options, 66.67% said their treatment plan was more sustainable, and 33.33% said their current treatment plan improved their symptoms. (Table Five).The majority of patients also strongly agreed (55.56%, table Five) After learning that PPI monotherapy induced histologic remission of EoE, undertaking a FED monotherapy trial improved overall quality of life and a treatment plan consistent with lifestyle and beliefs. helped identify the