title: Montelukast was inefficient in maintaining steroid-induced remission in adult eosinophilic esophagitis.
abstract: OBJECTIVE
  Leukotriene D4 is produced by and functions as a chemotactic factor for eosinophils. Eosinophilic esophagitis (EoE) is characterized by esophageal eosinophilic infiltration, determining structural changes and dismotility symptoms. Montelukast, a selective leukotriene D4 receptor antagonist, has gained increasing consideration as a therapeutic agent for EoE. However, limited available information has shown that montelukast is not effective in reducing eosinophilic infiltration. Our paper aims at evaluating whether montelukast could be consider as a steroid-sparing therapy by assessing its efficacy in maintaining both clinical and histopathological remission achieved after topical corticosteroids in adult EoE patients.
  
  
  METHODS
  Eleven consecutively diagnosed adult EoE patients were prospectively studied. Esophageal biopsies were obtained before and after a 6-month treatment with fluticasone propionate 400 μg/twice a day. Immediately after that, montelukast 10 mg/day was instituted. A new endoscopy was foreseen after a new 3-month period, or as soon as the patients presented esophageal symptoms. Symptoms were assessed by using a questionnaire before and after fluticasone propionate treatment and after montelukast therapy.
  
  
  RESULTS
  Eosinophils density into the esophageal epithelium and lamina propria was significantly reduced after a 6-month treatment with topical steroids (P = 0.003) and increased to levels similar to baseline level into the first 3 months after treatment with montelukast. Baseline symptom scores significantly decreased after treatment with topical steroids (P = 0.003) and increased again after montelukast therapy, but baseline levels improved.
  
  
  CONCLUSIONS
  Montelukast was not efficient in maintaining the histopathological or clinical response achieved by topical steroids in adult EoE patients.
authors.affiliation: Department of Gastroenterology, Hospital General de Tomelloso, Vereda de Socuéllamos, s/n, 13700, Tomelloso, Ciudad Real, Spain. alucendo@vodafone.es
authors.forename: Alfredo J
authors.initials: AJ
authors.lastname: Lucendo
authors.forename: Livia C
authors.initials: LC
authors.lastname: De Rezende
authors.forename: Susana
authors.initials: S
authors.lastname: Jiménez-Contreras
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Yagüe-Compadre
authors.forename: Jesús
authors.initials: J
authors.lastname: González-Cervera
authors.forename: Teresa
authors.initials: T
authors.lastname: Mota-Huertas
authors.forename: Danila
authors.initials: D
authors.lastname: Guagnozzi
authors.forename: Teresa
authors.initials: T
authors.lastname: Angueira
authors.forename: Sonia
authors.initials: S
authors.lastname: González-Castillo
authors.forename: Angel
authors.initials: A
authors.lastname: Arias
mesh_terms: D000085:Acetates / Q000008:administration & dosage / Q000627:therapeutic use*; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001706:Biopsy; D003521:Cyclopropanes; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D016099:Endoscopy, Gastrointestinal; D057765:Eosinophilic Esophagitis / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D011804:Quinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D012074:Remission Induction / Q000379:methods; D013440:Sulfides; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000085:Acetates; D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D003521:Cyclopropanes; D020024:Leukotriene Antagonists; D011804:Quinolines; D013440:Sulfides; D000068298:Fluticasone; C093875:montelukast