Comparison of Esomeprazole to Aerosolized, Swallowed Fluticasone for Eosinophilic Esophagitis

Abstract

Gastroesophageal reflux disease is common in adult eosinophilic esophagitis patients. Dysphagia improves and esophageal eosinophilic infiltration decreases with either treatment. There was no difference in degree of improvement in dysphagia or eosinophil infiltration in patients treated with either topical fluticasone or oral esomeprazole. GERD may be important in the pathogenesis of adult EoE.

Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis

“…Similar findings have previously been reported. 12 This study shows that GERD related OEI responds to acid suppression. It has also been shown that patients who do not have objective evidence of GERD, but have OEI may respond symptomatically and histologically to a PPI.…”

“…7 Peterson et al found abnormal 48-h Bravo studies in 56% (14 ⁄ 25) patients with OEI and dysphagia. 12 In a recent report, MolinaInfante found abnormal 24-h pH studies in 71% of patients with OEI without erosive oesophagitis. 14 Importantly, neither the density of eosinophilic infiltration nor endoscopic findings thought to be prototypical of OEI could differentiate between patients who did and did not have GERD.…”

“…Based on previous studies, we believed the likely proportion would be approximately 50%. 7,12,13 We determined that a sample size of 50 patients would provide a 95% confidence interval of 36-64%.…”

“…However, it is possible that the authors, and the consensus panels that produced the most recent diagnostic criteria for EoE 4,8 are incorrect in this assumption. It might be that PPIs work well in achieving histological and symptomatic response for OEI, 12,14 no matter what, the aetiology and defining which patients have GERD is solely an academic exercise. In summary, this study demonstrates that neither a positive nor a negative ambulatory pH study performed in patients with oesophageal eosinophilia is reliable in predicting response to treatment and therefore aetiology of the disease.…”

Systematic review of histological remission criteria in eosinophilic esophagitis

“…Although there were no common criteria to define histological remission in the studies reviewed, a majority of the randomized controlled trial studies used more stringent values ranging from 0 to ≤5 eosinophils/hpf to define histological remission or resolution 22, 26, 66, 67, 68. Compared to dietary treatment studies (e.g.…”