Dietary therapy can reverse esophageal subepithelial fibrosis in patients with eosinophilic esophagitis: a historical cohort

• Published in: Allergy (Copenhagen) Vol. 67; no. 10; pp. 1299 - 1307
• Main Authors: Lieberman, J. A., Morotti, R. A., Konstantinou, G. N., Yershov, O., Chehade, M.
• Format: Journal Article
• Language: English
• Published: Oxford Blackwell Publishing Ltd 01.10.2012; Blackwell
• Subjects: Adolescent; Adrenal Cortex Hormones - therapeutic use; Adult; Age; Allergies; Biological and medical sciences; Biopsy; Child; Child, Preschool; Children; Children & youth; Cohort Studies; Corticoids; corticosteroids; Degranulation; Dermatology; Diet; Dietary restrictions; eosinophilic esophagitis; Eosinophilic Esophagitis - complications; Eosinophilic Esophagitis - pathology; Epithelium; Epithelium - pathology; Esophagitis; Esophagus; Esophagus - pathology; Female; Fibrosis; Fibrosis - diet therapy; Fibrosis - etiology; Fibrosis - pathology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Hyperplasia; lamina propria; Leukocytes (eosinophilic); Male; Medical sciences; Other diseases. Semiology; remodeling; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Steroid hormones; Therapy; Treatment Outcome; Young Adult; Human; Corticosteroid; Immunopathology; Nutrition; Digestive system; Dermatology; Esophageal disease; Esophagitis; Remodeling; Eosinophil; Feeding; Esophagus; Immunology; Treatment; Diet; corticosteroids; Cohort study; Fibrosis; eosinophilic esophagitis; Digestive diseases; Reversibility
• ISSN: 0105-4538; 1398-9995
• DOI: 10.1111/j.1398-9995.2012.02881.x

Background Fibrosis of the esophageal lamina propria is a known complication of eosinophilic esophagitis (EoE). To date, therapy with topical corticosteroids has been shown to reverse esophageal fibrosis in some patients; however, there is little evidence to suggest that dietary therapy can also reverse it. Our aim was to examine whether dietary therapy alone can reverse esophageal fibrosis in children with EoE. Methods We performed a historical cohort study based on children with EoE who had esophageal fibrosis on pretreatment biopsies using trichrome staining. Post‐treatment biopsies were analyzed for fibrosis reversal, and results were compared between patients treated with dietary restriction and those that received topical steroids. Clinical characteristics (age, symptoms, duration of symptoms prior to therapy, treatment type, and duration of therapy) were recorded. Histological markers (eosinophil numbers and eosinophilic degranulation in both epithelium and lamina propria, basal zone hyperplasia, and the presence of eosinophilic microabscesses in the epithelium) were examined by reviewing hematoxylin and eosin‐stained biopsies and by immunohistochemical staining. These were examined as potential predictors for fibrosis reversal. Results Fibrosis resolved following both dietary restriction and topical steroids (3/17 and 5/9 patients respectively, P = 0.078). Post‐treatment symptom resolution and decreased intraepithelial eosinophil numbers were found to be the only significant predictors of fibrosis resolution. Conclusions Dietary restriction alone, similar to topical steroids, can reverse fibrosis in children with EoE.