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Clin Gastro H: 消除饮食中牛奶成分可对儿童嗜酸性食管炎具有治疗效果

2022-07-31 xuyihan MedSci原创

嗜酸细胞性食管炎是一种以嗜酸性粒细胞浸润为主要特征的慢性食管炎症。主要临床表现为吞咽梗阻、食物嵌顿及反流样症状等。

嗜酸性食管炎(EoE)是一种由抗原介导的慢性过敏性食管炎,此疾病对生活质量有显着影响。Kelly 等人确定了食物抗原在EoE中引发嗜酸性粒细胞增多的证据,当进行基本元素饮食后88-95%的受试者的症状得到了缓解,我们已知牛奶蛋白 (CMP) 是嗜酸性粒细胞增多症的常见诱因,在本项研究中研究人员试图评估饮食消除EoE 中所有含CMP食物后对于EoE的临床、内窥镜和组织学治疗效果。

研究人员接受1项食物消除饮食模式 (1FED) 治疗的 EoE 儿童进行了一项前瞻性观察研究。注册营养师对儿童及其看护人进行了关于饮食消除所有含 CMP 食物的教育,并通过替代品满足最佳生长和发育的营养需求以及日常膳食计划。治疗 8 至 12 周后进行上消化道内镜活检。主要观察终点是组织学缓解,定义为每个高倍视野少于 15 个嗜酸性粒细胞。次要终点是临床症状、内窥镜检查和生活质量 (QOL) 的改善。

研究结果显示41名儿童(76% 为男性)接受了 1FED 教育和治疗后内窥镜检查和活检。21 名(51%)儿童出现组织学缓解,每个高倍视野的嗜酸性粒细胞峰值从中位数 50(四分位距,35-70)降低到中位数 1(四分位距,0-6;P < .0001)。24 名 (59%) 患者的内镜异常得到改善,而 25 名 (61%) 患者的症状得到改善。改善的症状包括胸痛、吞咽困难和吞咽/吐出食物。

本项研究证实在超过50%的EoE患儿中,单单消除含有 CMP 的食物可导致EoE患者疾病组织学缓解,并导致症状和内窥镜异常的显着改善。

原始出处:

Joshua B. Wechsler. et al. A Single-Food Milk Elimination Diet Is Effective for Treatment of Eosinophilic Esophagitis in Children. Clinical Gastroenterology and Hepatology.2022.

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    2023-03-23 许安
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    2022-08-01 zhouqu_8
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