title: Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis.
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.
  
  
  METHODS
  Prospective randomized controlled trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Adults (18-80) diagnosed with EoE by symptoms of dysphagia and esophageal biopsies with >or=15 eosinophils/hpf.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Utah Health Sciences Center, Salt Lake City, UT, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Peterson
authors.forename: Kristen L
authors.initials: KL
authors.lastname: Thomas
authors.forename: Kristen
authors.initials: K
authors.lastname: Hilden
authors.forename: Lyska L
authors.initials: LL
authors.lastname: Emerson
authors.forename: Jason C
authors.initials: JC
authors.lastname: Wills
authors.forename: John C
authors.initials: JC
authors.lastname: Fang
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004802:Eosinophilia / Q000188:drug therapy*; D064098:Esomeprazole / Q000008:administration & dosage*; D004941:Esophagitis / Q000188:drug therapy*; D005260:Female; D000068298:Fluticasone; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D000336:Aerosols; D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000897:Anti-Ulcer Agents; D000068298:Fluticasone; D064098:Esomeprazole