PPI Plus 4-Food Elimination Diet vs PPI Only in Eosinophilic Esophagitis

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology annual meeting, taking place in San Francisco, California. Our staff will report on medical research related to asthma, allergy, and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI 2019.

SAN FRANCISCO — A 4-food elimination diet plus proton pump inhibitor (PPI) therapy was more effective than PPI therapy alone in children with eosinophilic esophagitis (EoE), according to the results of a randomized clinical trial presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology (AAAAI) held February 22-25 in San Francisco.

Researchers conducted a clinical trial in 3 centers in Australia from 2015 to 2017 in children with EoE (median age, 9.1 years). They compared remissions rates between children who were treated with omeprazole 1 mg/kg twice daily (maximum dose 20 mg twice daily) plus a 4-food elimination diet (cow’s milk, soy, egg, and wheat) vs children treated with omeprazole alone. All participants underwent a baseline gastroscopy and those with ≥15 eosinophils per high power field were included. A second gastroscopy was performed after 8 to 12 weeks. The researchers defined complete remission as eosinophils <5/high power field and partial remission as eosinophils <10/high power field.

Of the total 64 patients, 32 were randomly assigned to PPI therapy plus 4-food elimination diet and 32 to PPI alone. In the PPI plus 4-food elimination diet group, there was a higher rate of children who did not complete the study (5 vs 1). Both groups had similar median eosinophil counts at baseline (diet plus PPI, 37 vs PPI only, 44.5; P=.24). Children in the PPI plus 4-food elimination diet group had lower median mucosal eosinophil counts compared with children in the PPI only group at 8 to 12 weeks (2.5 vs 12; P =.11). Eosinophil counts were significantly different only in the lower esophagus (PPI plus diet group, 2 vs PPI only, 24; P =.003).

At least partial remission (<10 eosinophils/high power field) was significantly more likely in children treated with PPI plus 4-food elimination diet vs PPI only (88% vs 45%; P =.002), with slight significance in the intention-to-treat analysis (PPI plus diet, 69% vs PPI only, 44%; P =.054).

Presenting author Ralf G. Heine, MD, FRACP, of the Murdoch Childrens Research Institute in Melbourne, noted that while these interventions approved outcomes, 30% to 50% of children may still require treatment additional treatment modalities, so further research is required.

This is the first clinical trial to demonstrate superior effectiveness of PPI therapy plus 4-food elimination diet vs PPI monotherapy in children with EoE.

Visit Pulmonology Advisor‘s conference section for continuous coverage from AAAAI 2019.

Reference

Heine RG, Peters R, Cameron DJ, et al. Effect of a 4-food elimination diet and omeprazole in children with eosinophilic esophagitis — a randomized controlled trial. Presented at: American Academy of Allergy, Asthma & Immunology annual meeting 2019; February 22-25, 2019; San Francisco, CA. Abstract 936.