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

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.

• Authors: Cary C Cotton, Swathi Eluri, W Asher Wolf, Evan S Dellon
• Journal: Digestive diseases and sciences (Dig Dis Sci) Vol. 62 Issue 9 Pg. 2408-2420 (09 2017) ISSN: 1573-2568 [Electronic] United States
• PMID: 28608048 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)

Chemical References

• Steroids

Topics

• Administration, Topical
• Eosinophilic Esophagitis (diet therapy, drug therapy)
• Humans
• Steroids (administration & dosage)
• Treatment Outcome