PMID- 25493035
OWN - NLM
STAT- MEDLINE
DCOM- 20150903
LR  - 20181113
IS  - 2219-2840 (Electronic)
IS  - 1007-9327 (Print)
IS  - 1007-9327 (Linking)
VI  - 20
IP  - 45
DP  - 2014 Dec 7
TI  - Test-based exclusion diets in gastro-esophageal reflux disease patients: a 
      randomized controlled pilot trial.
PG  - 17190-5
LID - 10.3748/wjg.v20.i45.17190 [doi]
AB  - AIM: To investigate the clinical response of gastro-esophageal reflux disease 
      (GERD) symptoms to exclusion diets based on food intolerance tests. METHODS: A 
      double blind, randomized, controlled pilot trial was performed in 38 GERD 
      patients partially or completely non-responders to proton pump inhibitors (PPI) 
      treatment. Fasting blood samples from each patients were obtained; leukocytotoxic 
      test was performed by incubating the blood with a panel of 60 food items to be 
      tested. The reaction of leukocytes (rounding, vacuolization, lack of movement, 
      flattening, fragmentation or disintegration of cell wall) was then evaluated by 
      optical microscopy and rated as follows: level 0 = negative, level 1 = slightly 
      positive, level 2 = moderately positive, and level 3 = highly positive. A "true" 
      diet excluding food items inducing moderate-severe reactions, and a "control" 
      diet including them was developed for each patient. Then, twenty patients 
      received the "true" diet and 18 the "control" diet; after one month (T1) symptoms 
      severity was scored by the GERD impact scale (GIS). Hence, patients in the 
      "control" group were switched to the "true" diet, and symptom severity was 
      re-assessed after three months (T2). RESULTS: At baseline (T0) the mean GIS 
      global score was 6.68 (range: 5-12) with no difference between "true" and control 
      group (6.6 +/- 1.19 vs 6.7 +/- 1.7). All patients reacted moderately/severely to at 
      least 1 food (range: 5-19), with a significantly greater number of food 
      substances inducing reaction in controls compared with the "true" diet group 
      (11.6 vs 7.0, P < 0.001). Food items more frequently involved were milk, lettuce, 
      brewer's yeast, pork, coffee, rice, sole asparagus, and tuna, followed by eggs, 
      tomato, grain, shrimps, and chemical yeast. At T1 both groups displayed a 
      reduction of GIS score ("true" group 3.3 +/- 1.7, -50%, P = 0.001; control group 
      4.9 +/- 2.8, -26.9%, P = 0.02), although the GIS score was significantly lower in 
      "true" vs "control" group (P = 0.04). At T2, after the diet switch, the "control" 
      group showed a further reduction in GIS score (2.7 +/- 1.9, -44.9%, P = 0.01), 
      while the "true" group did not (2.6 +/- 1.8, -21.3%, P = 0.19), so that the GIS 
      scores didn't differ between the two groups. CONCLUSION: Our results suggest that 
      food intolerance may play a role in GERD symptoms development, and leucocytotoxic 
      test-based exclusion diets may be a possible therapeutic approach when PPI are 
      not effective or indicated.
FAU - Caselli, Michele
AU  - Caselli M
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Zuliani, Giovanni
AU  - Zuliani G
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Cassol, Francesca
AU  - Cassol F
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Fusetti, Nadia
AU  - Fusetti N
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Zeni, Elena
AU  - Zeni E
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Lo Cascio, Natalina
AU  - Lo Cascio N
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Soavi, Cecilia
AU  - Soavi C
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
FAU - Gullini, Sergio
AU  - Gullini S
AD  - Michele Caselli, Giovanni Zuliani, Francesca Cassol, Cecilia Soavi, Department of 
      Medical Sciences, Internal Medicine Institute, University of Ferrara, 44100 
      Ferrara, Italy.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PL  - United States
TA  - World J Gastroenterol
JT  - World journal of gastroenterology
JID - 100883448
SB  - IM
MH  - Adult
MH  - Double-Blind Method
MH  - Female
MH  - Food Hypersensitivity/complications/diagnosis/*diet therapy/immunology
MH  - Gastroesophageal Reflux/diagnosis/*diet therapy/etiology/immunology
MH  - Humans
MH  - Leukocytes/immunology
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Prospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC4258591
OTO - NOTNLM
OT  - Exclusion diet
OT  - Food intolerance
OT  - Gastro-esophageal reflux disease
OT  - Leukocytotoxic test
OT  - Treatment
EDAT- 2014/12/11 06:00
MHDA- 2015/09/04 06:00
PMCR- 2014/12/07
CRDT- 2014/12/11 06:00
PHST- 2014/01/06 00:00 [received]
PHST- 2014/04/29 00:00 [revised]
PHST- 2014/07/24 00:00 [accepted]
PHST- 2014/12/11 06:00 [entrez]
PHST- 2014/12/11 06:00 [pubmed]
PHST- 2015/09/04 06:00 [medline]
PHST- 2014/12/07 00:00 [pmc-release]
AID - 10.3748/wjg.v20.i45.17190 [doi]
PST - ppublish
SO  - World J Gastroenterol. 2014 Dec 7;20(45):17190-5. doi: 10.3748/wjg.v20.i45.17190.