Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate.
BACKGROUND
Eosinophilic esophagitis is an increasingly recognized disorder characterized by intense eosinophilic infiltration of the esophageal mucosa. The aim of this study was to define the clinical syndrome, the endoscopic features, and the distribution of the eosinophil infiltrate in adults with eosinophilic esophagitis. We undertook a prospective evaluation of the symptomatic and histologic response to treatment with fluticasone propionate.


METHODS
Twenty-six patients (18 men; mean age 36 years) had symptom assessment and barium studies, esophageal motility recordings, and 24-hour esophageal pH studies. Upper-GI endoscopy was performed with quantitative eosinophil counts of biopsy specimens from the proximal and distal esophagus, the gastric antrum, and the duodenum. Nineteen subjects received 4 weeks of swallowed fluticasone propionate. After treatment, symptom assessment and endoscopic biopsies were repeated.


RESULTS
All 26 patients had a history of dysphagia, and 11 presented acutely with food-bolus obstruction. Esophageal peristalsis was normal in most and gastroesophageal reflux coexisted in 10 patients. Characteristic endoscopic findings of furrows (20) and rings (18) were observed. All 19 treated patients had symptom improvement and a significant decrease in esophageal eosinophil counts.


CONCLUSIONS
Eosinophilic esophagitis is a distinct entity that may coexist with gastroesophageal reflux. Swallowed fluticasone propionate is an effective treatment.
Remedios
Matthew
M
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Campbell
Catherine
C
Jones
Dianne M
DM
Kerlin
Paul
P
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D003680:Deglutition Disorders / Q000209:etiology; D004386:Duodenum / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004804:Eosinophils / Q000473:pathology; D004941:Esophagitis / Q000188:drug therapy* / Q000473:pathology* / Q000503:physiopathology; D004947:Esophagus / Q000473:pathology; D000068298:Fluticasone; D005764:Gastroesophageal Reflux / Q000150:complications; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D009092:Mucous Membrane / Q000473:pathology; D011446:Prospective Studies; D011706:Pyloric Antrum / Q000473:pathology
D000305:Adrenal Cortex Hormones; D000730:Androstadienes; D000068298:Fluticasone