Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis.
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.
Peterson
Kathryn A
KA
University of Utah Health Sciences Center, Salt Lake City, UT, USA.
Thomas
Kristen L
KL
Hilden
Kristen
K
Emerson
Lyska L
LL
Wills
Jason C
JC
Fang
John C
JC
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
D000336:Aerosols; D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000897:Anti-Ulcer Agents; D000068298:Fluticasone; D064098:Esomeprazole