Mo1869 Inverse Correlation of H. pylori and Eosinophilic Esophagitis

Abstract

INTRODUCTION: Repeated esophagogastroduodenoscopies (EGDs) are required to identify food trigger(s) in patients with esophagitis (EoE) treated with dietary therapy. However, there is limited data on the safety of repeated endoscopic procedures in these patients. OBJECTIVE: To evaluate the safety of serial EGDs in EoE patients undergoing dietary treatment. METHODS: A literature review and an analysis of our internal database were conducted to determine the safety of EGDs in identifying food trigger(s) in EoE. Using Pubmed database, a systematic search was performed for published articles since 1977 with a combination of keywords eosinophilic esophagitis, endoscopy, esophagogastroduodenoscopies, safety, complications, and outcome. Reports studying dietary treatment for EoE were included for the analysis if the presence or absence of EGD complications was reported. Furthermore, we retrospectively reviewed the medical and endoscopy records of all the EoE patients who underwent dietary therapy at Massachusetts General Hospital Food Allergy Center (MGH FAC) from 2010-2013. Diagnosis of EoE was defined as 1 or more biopsies showing >15 eosinophils/hpf after at least 6 weeks of high dose proton pump inhibitor. RESULTS: Our literature search identified 408 references, of which 5 were included in the final analysis. Four are retrospective studies while one is prospective. Only one article explicitly reported the average number EGD per patient (5.6, n = 39, JPGN 2011;53: 145-149). At MGH FAC, 81 EoE patients underwent an average of 7.1 EGDs/patient to identify food trigger(s). From our dataset and the selected articles, there were a total of 542 EoE patients (71.0% male, mean age of 11.9 ± 10.7) who underwent diagnostic EGDs for dietary treatment. Three studies described clinical outcomes of serial food reintroduction to identify food trigger(s) and the overall success rate for identification of a trigger food was 96%. There were no EGD-associated complications in all five published studies and in our institution. DISCUSSION: Serial EGDs are safe and effective in identifying food trigger(s) in EoE.