title: A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis.
abstract: BACKGROUND
  Elimination diets and high-dose proton pump inhibitors (PPI) are advocated as first-line treatments in patients with eosinophilic oesophagitis (EoE).
  
  
  OBJECTIVE
  To record the treatment outcome for patients with EoE prospectively managed according to a clinical algorithm.
  
  
  METHODS
  Patients with oesophageal eosinophilia commenced esomeprazole 40 mg twice daily for 8 weeks. Those in histological remission were re-classified as PPI-responsive oesophageal eosinophilia. Nonresponders were offered the 6-food elimination diet with a PPI, or topical budesonide monotherapy (1 mg orally twice daily as an aqueous gel). Once disease control was achieved remission was reassessed at 3 months (all modalities) and an additional 6 months (diet group).
  
  
  RESULTS
  Of 107 patients who completed 8 weeks of PPI, 25 (23%) were PPI-responsive. 56 of 81 (69%) of patients with EoE chose the elimination diet with PPI. 29 (52%) had complete remission, 23 completed dietary reintroduction and food triggers were identified in 20 (36%). 25 chose budesonide with 23/25 (92%) responding. Remission was sustained in >85% of patients at 3 months with all treatment modalities. At 9 months, only 10/18 (55%) of patients who responded to the elimination diet with PPI remained complaint and sustained remission.
  
  
  CONCLUSIONS
  Many patients previously diagnosed with EoE will respond to PPI. Initial response >50% is possible with the elimination diet plus PPI, but many will fail to undergo food reintroduction, or will cease the diet and relapse, resulting in only one in four patient sustaining remission at 9 months. Budesonide is very effective short term, but longer term study is needed.
authors.affiliation: Monash University, Melbourne, Vic., Australia.|Eastern Health, Melbourne, Vic., Australia.|The Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: H
authors.initials: H
authors.lastname: Philpott
authors.affiliation: Monash University, Melbourne, Vic., Australia.|Eastern Health, Melbourne, Vic., Australia.
authors.forename: S
authors.initials: S
authors.lastname: Nandurkar
authors.affiliation: Monash University, Melbourne, Vic., Australia.
authors.forename: S G
authors.initials: SG
authors.lastname: Royce
authors.affiliation: Monash University, Melbourne, Vic., Australia.|Eastern Health, Melbourne, Vic., Australia.
authors.forename: F
authors.initials: F
authors.lastname: Thien
authors.affiliation: Monash University, Melbourne, Vic., Australia.|The Alfred Hospital, Melbourne, Vic., Australia.
authors.forename: P R
authors.initials: PR
authors.lastname: Gibson
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D057765:Eosinophilic Esophagitis / Q000178:diet therapy* / Q000188:drug therapy*; D064098:Esomeprazole / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D054328:Proton Pump Inhibitors; D019819:Budesonide; D064098:Esomeprazole