title: Results of ambulatory pH monitoring do not reliably predict response to therapy in patients with eosinophilic oesophagitis.
abstract: BACKGROUND
  The consensus statements for eosinophilic oesophagitis recommend that ambulatory pH monitoring is one means of determining if gastro-oesophageal reflux is the cause of oesophageal eosinophilia and should guide pharmacological therapy.
  
  
  OBJECTIVE
  To evaluate prospectively the accuracy of pH monitoring as a predictor of endoscopic, histological and symptomatic response in patients with oesophageal eosinophilia.
  
  
  METHODS
  We conducted a prospective trial in which patients with oesophageal eosinophilic infiltration with ≥15 eos/hpf underwent a 24-h pH study and were placed in one of two treatment arms for 6 weeks based on positive or negative results. Patients with abnormal acid exposure were treated with esomeprazole 40 mg twice daily and others were treated with oral viscous budesonide 1 g twice daily. Response to treatment was assessed by oesophageal histology (<5 eos/hpf) and symptoms.
  
  
  RESULTS
  A total of 51 patients were enrolled in the study. The average patient age was 39 years and 31 patients (61%) were male. The average number of eosinophils per hpf, prior to study enrolment was 41.2 (range 15-140, s.d. 27.7). Nineteen (37%) had positive pH studies and 32 (63%) had negative pH studies. Eighteen patients completed treatment with esomeprazole. Only eleven (61%) had histological response and, of these eleven, five (46%) had symptomatic improvement. A total of 28 patients with normal acid exposure completed treatment with budesonide. Only 16 (57%) had histological and 11 (69%) had symptomatic improvement.
  
  
  CONCLUSIONS
  In this prospective trial of pH-guided treatment, neither positive nor negative results of initial pH monitoring accurately predicted response to therapy.
authors: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, USA. francis.dawn@mayo.edu
authors: D L
authors: DL
authors: Francis
authors: A
authors: A
authors: Foxx-Orenstein
authors: A S
authors: AS
authors: Arora
authors: T C
authors: TC
authors: Smyrk
authors: K
authors: K
authors: Jensen
authors: S L
authors: SL
authors: Nord
authors: J A
authors: JA
authors: Alexander
authors: Y
authors: Y
authors: Romero
authors: D A
authors: DA
authors: Katzka
mesh_terms: D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D019819:Budesonide / Q000008:administration & dosage*; D057765:Eosinophilic Esophagitis / Q000188:drug therapy* / Q000503:physiopathology; D064098:Esomeprazole / Q000008:administration & dosage*; D005260:Female; D005745:Gastric Acidity Determination; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D000897:Anti-Ulcer Agents; D019819:Budesonide; D064098:Esomeprazole