Mo1831 Trans-Nasal Gastroscopy Without Sedation for Eosinophilic Esophagitis; Safe, Effective and the Ideal Method of Assessment?

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disorder triggered by food antigens. A six-food elimination diet (SFED) achieves histological remission in around 75% of adult EoE patients. The most common food triggers identified have been milk, wheat, egg and soy and/or legumes, with a minor role for nuts and fish/ seafood. Less restrictive dietary interventions might improve patient acceptance of dietary limitations and reduce the number of endoscopies and overall time to complete the food reintroduction process. Methods: Prospective multicenter study in consecutive adult patients with EoE, defined by consensus guidelines. An optimized four-food elimination diet (FFED) (dairy products, gluten, egg and legumes, including soy and peanut) was designed to avoid to the maximum cross-reactivity between food allergens. All patients underwent histological re-evaluation after 6 weeks on FFED. Response to FFED was defined by clinical and histological ( 50% reduction in their peak eosinophil density, whereas clinical and histological remission was accomplished in 22 patients (51%). To date, 10 patients have finished the food reintroduction process (5 patients with a single food trigger, 5 patients with two food triggers). The most common causative food allergens have been dairy (58%), egg (50%), gluten (26%) and legumes (20%). Among 21 non-responders to FFED, 12 patients underwent rescue SFED, of whom 6 (50%) achieved clinico-pathological remission. Conclusion: Clinico-pathologic remission was accomplished in 50% of EoE patients following a FFED and in 50% of FFED non-responders undergoing rescue SFED. FFED is a cheaper, faster and less inconvenient dietary intervention, effective in 2 out of every 3 adult EoE patients responder to SFED.