Dietetic Versus Topical Steroids for Pediatric Eosinophilic Esophagitis
Status:
Completed
Trial end date:
2013-06-01
Target enrollment:
Participant gender:
Summary
Therapeutic strategies for eosinophilic esophagitis (EoE) actually include: 1) allergen
avoidance through dietary modifications, and 2) pharmacologic antiinflammatory therapy.
Medical treatment is mainly based on topical administration of corticosteroids by swallowing
fluticasone propionate or budesonide spray. Dietetic treatment with highest efficacy is
elemental diet, consisting in exclusive feeding with amino-acid based formulas, often
administered trough SNG. Alternative choices of acceptable efficacy are empirical six-foods
elimination diet (cow's milk, egg, soy, wheat, peanuts, fish) and targeted elimination diet
based on the results of allergy tests. Most of the paediatric patients with EE respond to
elemental or targeted elimination diets, and therefore such authors recommend elimination
diets to be considered the treatment of choice in children. However, elimination diets can
often be complex to follow and may be associated with poor adherence owing to the low
palatability of a highly restricted diet. In non-compliant patients, especially in
adolescents and young adults, it may be more practical to proceed first with corticosteroid
treatment. In the case of partial response to elimination diets or corticosteroids, a
combination of both treatment mod. However, there has been limited testing of these regimens
in randomized controlled trials, while most of available literature is based on case series.
The aim of this study was to compare the efficacy of six-foods elimination diet, swallowed
fluticasone, swallowed budesonide and oral viscous budesonide (OVB) in pediatric patients
with active EoE. The investigators assessed the effects of randomly assigned treatment on
clinical and endoscopic/histologic severity as primary and secondary outcomes, respectively.
The investigators describe clinical, allergological, endoscopic and histological features,
and pH study results, of our pediatric population.