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Arias A.,Research Unit | Lucendo A.J.,Hospital General de Tomelloso
Expert Review of Clinical Immunology

Eosinophilic esophagitis (EoE) represents a prevalent chronic esophageal disorder. Since the condition was first described, its pathophysiology has been known to have an immune-allergic origin, but the high response rate to dietary therapies based on feeding patients exclusively with amino acid-based elemental formulas (with complete elimination of table foods) has clearly established EoE as a particular form of food allergy. Nevertheless, the management of EoE in clinical practice remains widely heterogeneous, with topical steroids being a therapeutic mainstay. However, a growing body of evidence points to dietary therapy as an effective treatment option for both children and adults with EoE, as this approach is capable of achieving a sustained symptomatic and histological response without resorting to drugs. This article reviews the available data on the major types of dietary therapy for EoE, including elemental formula diets, skin allergy testing-directed elimination diets and empirical elimination diets based on common food allergens. © 2014 Informa UK, Ltd. Source

Garcia-Manzanares A.,Area de Atencion Especializada la Mancha Centro | Lucendo A.J.,Hospital General de Tomelloso
Nutrition in Clinical Practice

Celiac disease (CD) is a primarily digestive systemic disease triggered and maintained by the ingestion of gluten in the diet. Its has a wide clinical spectrum of manifestations, particularly varied in adult patients, in whom, because of their frequent negative serology and mild, nonspecific symptoms, there is a considerable delay in diagnosis. The intestinal lesion caused by CD leads to various deficiencies of nutrients, vitamins, and dietary minerals, with ferropenia, vitamin B12, folic acid, and fat-soluble vitamin deficiencies being especially frequent. The deficiencies, together with dairy intolerance, cause low bone density and an increased risk of fractures. Treatment using a gluten-free diet (GFD) does involve certain complications, since gluten is found in up to 70% of manufactured food products and manufacturing regulations are not standard in all countries. In addition, certain nutrient deficiencies require specific management. This article reviews the nutritional aspects of CD and provides practical guidelines to correct these deficiencies and to ensure optimum GFD compliance. © 2011 American Society for Parenteral and Enteral Nutrition. Source

Lucendo A.J.,Hospital General de Tomelloso
Current Gastroenterology Reports

Eosinophilic esophagitis (EoE) is a prevalent chronic esophageal disorder, triggered and maintained by immunologically mediated responses against dietary antigens. EoE represents the most recent form of food allergy, and its control by avoiding offending foods has increasingly appeared as a therapeutic alternative to achieve and maintain remission. Dietary therapies have proved equally effective in pediatric and adult EoE patients, among whom various types of interventions to eliminate or reduce food antigens exposure have been evaluated. A recent meta-analysis showed elemental diet as the most effective option to induce disease remission, but with a limited application in clinical practice. Inconsistency and wide variability in results from skin allergy testing-directed food restriction contributed to dissatisfaction with implementation of this option, which subsequently was displaced by empiric elimination of common food allergens. Such empiric elimination of common food allergens is now recognized as the best alternative for dietary treatment, with moderate-to-high efficiency and reproducible results. This review provides evidence-based insights into the dietary management of EoE. © 2015, Springer Science+Business Media New York. Source

Lucendo A.J.,Hospital General de Tomelloso
Scandinavian Journal of Gastroenterology

Eosinophilic gastrointestinal disorders (EGIDs) are a diverse group of disorders whose diagnosis is on the rise and are characterized by symptoms caused by infiltration by eosinophils of the different sections of the digestive tract. Although little is known of their etiology, it seems to be multifactorial. Alteration of the immunological capacity of the digestive mucosa is determined by the exposure of genetically predisposed individuals to potential airborne or food allergens. EGIDs are classified based on the location of the inflammatory response even though their symptoms, prognosis, and treatment vary considerably. Eosinophilic esophagitis is the most widely recognized entity in this family and is characterized by exclusive eosinophilic infiltration of the esophagus. Breakthroughs in understanding its etiopathogeny have been extrapolated to eosinophilic gastroenteritis, a rare disease identified many years ago commonly involving the stomach and small bowel which should be distinguished from hypereosinophilic syndrome. Eosinophilic colitis, which usually affects children, could be considered a specific non-IgE-mediated allergy to food protein. The physiopathological bases of these entities need to be established in order to define specific treatment aimed at preventing and altering their clinical evolution. © 2010 Informa Healthcare. Source

Lucendo A.J.,Hospital General de Tomelloso
Expert Review of Gastroenterology and Hepatology

Eosinophilic esophagitis (EoE) is a pathophysiologically complex disorder driven by distinct, multiple mechanisms involving a large number of cells, molecules, and genes. Associated with food allergy from its initial descriptions, a key role for the Th2-type cytokines IL-5 and IL-13 in recruiting and activating eosinophils has been described. Epithelial cells have been recognized as major effectors in initiating EoE, both through their recruitment of iNKT cells towards the esophageal epithelium, which constitutes a major cytokine source, and through the release of eotaxin-3 and other chemoattractants. Epithelial and mesenchymal-released TSLP is a key regulator for which a connecting role between the adaptive and innate mucosal-associated immune response has been suggested. Finally, activated eosinophil- and mast cell-derived TGF β1 secretion is crucial in EoE-associated tissue remodeling. © 2014 Informa UK, Ltd. Source

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