Combination Steroid and Test-based Food Elimination for Eosinophilic Esophagitis: A Retrospective Analysis

Objectives: Eosinophilic esophagitis (EoE) is a clinicopathologic disorder characterized by infiltration of eosinophils into the esophagus. Primary treatment approaches include topical corticosteroids and/or food elimination. The aim of the present study was to compare the effectiveness of combination therapy (topical corticosteroid plus test-based food elimination [FS]) with single therapy (topical corticosteroid [S] or test-based food elimination [F]). Methods: Chart review of patients with EoE at Texas Children's Hospital (age <21 years) was performed. Clinical and histological statuses were evaluated after a 3-month treatment with either single or combination therapy. Comparisons were analyzed using Fisher exact test, Kruskal-Wallis tests, and multiple logistic regression models. Results: Among 670 charts, 63 patients (1-21 years, median 10.3 years) with clinicopathologic diagnoses of EoE were identified. Combination FS therapy was provided to 51% (nhairsp;=&hairsp;32) and single treatment (S, F) to 27% (n&hairsp;=&hairsp;17) or 22% (n&hairsp;=&hairsp;14) of patients, respectively. Clinical responses were noted in 91% (n&hairsp;=&hairsp;29), 71% (n&hairsp;=&hairsp;12), and 64% (n&hairsp;=&hairsp;14) of patients in the FS, S, and F groups, respectively. The odds of clinically improving were 4.6 times greater (95% confidence interval: 1.1-18.8) with combination versus single therapy. The median peak number of eosinophils per high-power field after 3-month therapy was not significantly different in the S, F, and FS groups. Conclusions: The combination of topical corticosteroids with specific food elimination is as effective in achieving clinical and histological remissions as the single-Treatment approaches. Responses were achieved with the combination in patients who had previously failed single-Agent therapy. Prospective research of this combination approach in young patients with EoE is needed.