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Six-Food Elimination Diet and Topical Steroids are Effective for Eosinophilic Esophagitis: A Meta-Regression

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Abstract

Background

Topical corticosteroids or six-food elimination diet is recommended as initial therapy for eosinophilic esophagitis (EoE).

Aims

We aimed to summarize published manuscripts that report outcomes of these therapies for EoE.

Methods

We performed a systematic review in MEDLINE, Web of Science, and Embase of published manuscripts describing topical fluticasone, topical budesonide, and six-food elimination diet as therapies for EoE. We conducted meta-analysis of symptom improvement and the change in peak mucosal eosinophil count, with heterogeneity between studies examined with meta-regression analysis.

Results

Systematic review yielded 51 articles that met inclusion criteria. Summary histologic response rates were 68.3% [95% prediction limits (PL) 16.2–96.0%] for fluticasone, 76.8% (95% PL 36.1–95.1%) for budesonide, and 69.0% (95% PL 31.9–91.4%) for six-food elimination diet. Corresponding decreases in eosinophil counts were 37.8 (95% PL 19.0–56.7), 62.5 (95% PL 125.6 to −0.67, and 44.6 (95% PL 26.5–62.7), respectively. Symptom response rates were 82.3% (95% PL 68.1–91.1%), 87.9% (95% PL 42.7–98.6%), and 87.3% (95% PL 64.5–96.3%), respectively. Meta-regression analyses decreased the initially large estimate of residual heterogeneity and suggested differences in histologic response rate associated with study populations’ baseline eosinophil count and age.

Conclusions

The literature describing topical corticosteroids and six-food elimination diet consists of small studies with diverse methods and population characteristics. Meta-analysis with meta-regression shows initial histologic and symptomatic response rates on the same order of magnitude for topical corticosteroids and six-food elimination diet, but heterogeneity of study designs prevents direct comparison of modalities.

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Acknowledgments

This research was funded by NIH Awards T32 DK007634 (CCC, SE, WAW), and R01DK101856 (ESD).

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  1. Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, University of North Carolina at Chapel Hill, CB # 7080, Bioinformatics Bldg, 130 Mason Farm Rd, Chapel Hill, NC, 27599-7080, USA

    Cary C. Cotton, Swathi Eluri, W. Asher Wolf & Evan S. Dellon

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  1. Cary C. Cotton
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Correspondence to Evan S. Dellon.

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Dr. Dellon is consultant for Adare, Alivio, Banner, Receptos/Celgene, Regeneron, and Shire, has received grant funding from Meritage, Miraca, Nutricia, Receptos/Celegene, Regeneron, and Shire, and has received an educational grant: Banner. The other authors have no potential conflicts related to this manuscript to report.

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Cotton, C.C., Eluri, S., Wolf, W.A. et al. Six-Food Elimination Diet and Topical Steroids are Effective for Eosinophilic Esophagitis: A Meta-Regression. Dig Dis Sci 62, 2408–2420 (2017). https://doi.org/10.1007/s10620-017-4642-7

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