S1864 The Utility of Specific Symptoms and Endoscopic Features As Predictors of Eosinophilic Esophagitis (EoE) in Adults

Abstract

Background: Eosinophilic gastroenteritis (EG) is a rare disorder whose pathogenesis is poorly understood. To date there are no reports of dietary elimination in adults with EG. Aim: To evaluate the effectiveness of therapy with six food elimination diet (SFED) or elemental diet (ED) in adults with EG. Methods: Adults with a histologic diagnosis of EG were treated with either SFED or ED for 6 wks. All pts were off steroid or immunomodulators prior to inclusion and during the study period and were ruled out for H pylori and other infections. Pts met with a dietician for counseling and compliance. After 6 wks, pts had repeat EGD with biopsies in the proximal/distal esophagus, stomach and duodenum. Response was defined as peak count < 5 eos/hpf in the esophagus and <10 eos/hpf in gastric or duodenal specimens. If pts did not respond to SFED, they were offered 6 wks of ED. Results: 9 pts (6M) have been included to date. Average age was 35yrs (27-49) with median duration of symptoms of 13.5yrs (0.25-37). All pts had gastric involvement and 3/9 and 6/9 pts also had duodenal and esophageal eosinophilia, respectively. Common symptoms were abdominal pain (7), diarrhea (4), weight loss (4), dysphagia (4) nausea/vomiting (3) and fatigue (3). Complications of EG included anemia (4), malnutrition (2), osteoporosis (2) non-healing ulcer disease (1) and duodenal stricture (1). 89% of pts were atopic and 44% had history of food allergies. Skin prick testing for aero and food allergens were positive in 100% of the 77% of pts tested. Endoscopic findings were gastric erythema (100%) and nodularity (56%), duodenal erythema (22%) and nodularity (11%). All pts with dysphagia had features consistent with eosinophilic esophagitis (EoE) including rings (75%) furrows (75%), small caliber (50%), and stricture (25%). Diagnosis of EG preceded EoE in 50% of EG+EoE pts by an average of 10 yrs. No pts with pre-existing EoE progressed to EG. 89% of pts had peripheral eosinophilia (absolute eosinophil counts 1100-3900k/ul). IgE levels were high in 4/6 pts tested. 7/9 pts were initially treated with SFED and 2 pts with ED. 4/7 pts on SFED and 2/2 pts on ED had resolution of symptoms, histologic and peripheral eosinophilia. The remaining 3 pts on SFED had symptomatic but not histologic improvement, therefore are now undergoing ED. Conclusions: (1) Dietary elimination is effective in reducing symptoms, histologic and peripheral eosinophilia in 4/7 EG adults on SFED and 2/2 on ED implicating food allergens in the etiopathogenesis. (2) Further trials of dietary elimination in adults with EG are warranted.