Display Settings:

Format

Send to:

Choose Destination
Dig Dis Sci. 2010 May;55(5):1313-9. doi: 10.1007/s10620-009-0859-4. Epub 2009 Jun 18.

Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis.

Author information

  • 1University of Utah Health Sciences Center, Salt Lake City, UT, USA.

Abstract

BACKGROUND:

Both gastroesophageal reflux disease and allergy/atopy have been implicated in the pathogenesis of eosinophilic esophagitis (EoE). There are no prospective studies comparing treatment of EoE with acid suppression versus topical corticosteroids.

OBJECTIVE:

To determine the outcome of adult eosinophilic esophagitis patients treated with esomeprazole versus topical fluticasone.

DESIGN:

Prospective randomized controlled trial.

SETTING:

Academic medical center.

PARTICIPANTS:

Adults (18-80) diagnosed with EoE by symptoms of dysphagia and esophageal biopsies with >or=15 eosinophils/hpf.

INTERVENTIONS:

Subjects were randomized to esomeprazole (40 mg by mouth every morning) or aerosolized, swallowed fluticasone (440 mcg by mouth twice a day) for 8 weeks.

MAIN OUTCOME MEASUREMENTS:

Improvement in dysphagia (8-point scale), esophageal eosinophil infiltration before and after treatment, prevalence of GERD measured by validated questionnaire and baseline pH study.

RESULTS:

About 56% (14/25) had acid reflux by pH study. There was no difference between treatment groups in improvement in dysphagia scores [3/12 (25%) of the esomeprazole group versus 6/12 (50%) in the fluticasone group, P = 0.40]. Eosinophil infiltration decreased with treatment in both groups, and there was no difference in the amount of decrease between groups (P = 0.70).

LIMITATIONS:

Small sample size, unexpectedly high drop-out rate.

CONCLUSIONS:

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.

PMID:
19533356
[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Springer
    Loading ...
    Write to the Help Desk